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Association between implantable loop recorder use and secondary stroke prevention: a meta-analysis
Wen-Yi Huang1, Bruce Ovbiagele2, Cheng-Yang Hsieh3
1Neurology, Chang Gung Memorial Hospital Keelung Branch, Keelung, Taiwan.
Open Heart
|June 16, 2022
Summary
Implantable loop recorders (ILRs) did not significantly reduce recurrent stroke risk in ischemic stroke patients. While ILRs increased atrial fibrillation detection and oral anticoagulant initiation, further trials are needed to confirm stroke prevention benefits.
Area of Science:
- Cardiology
- Neurology
- Clinical Trials
Background:
- Ischemic stroke recurrence is a significant concern.
- Early detection of atrial fibrillation (AF) is crucial for stroke prevention.
- Implantable loop recorders (ILRs) offer prolonged cardiac monitoring.
Purpose of the Study:
- To evaluate the efficacy of ILRs in reducing recurrent stroke after an initial ischemic stroke.
- To assess the impact of ILRs on AF detection and oral anticoagulant (OAC) initiation.
Main Methods:
- A meta-analysis of randomized controlled trials (RCTs) comparing ILR versus non-ILR in ischemic stroke patients.
- Searched PubMed, EMBASE, CENTRAL, and ClinicalTrials.gov from 1966 to November 2021.
- Calculated relative risk (RR) with 95% confidence intervals (CI) using a fixed-effect model.
Main Results:
- Three RCTs with 1233 patients were included.
- ILR use was not associated with a significant reduction in recurrent stroke (RR 0.70; 95% CI 0.42-1.19) or recurrent ischemic stroke (RR 0.72; 95% CI 0.48-1.10).
- ILR patients showed significantly higher rates of AF detection (RR 5.31; 95% CI 3.10-9.11) and OAC initiation (RR 2.77; 95% CI 1.90-4.03).
Conclusions:
- ILRs did not significantly decrease the risk of recurrent stroke or recurrent ischemic stroke.
- Despite increased AF detection and OAC initiation, stroke risk reduction was not significant.
- Larger, adequately powered RCTs are necessary to definitively assess ILR's role in stroke prevention.
