Implantable Cardiac Monitoring for Atrial Fibrillation Detection in Patients with Stroke: A Systematic Review and...

Area of Science:

• Cardiology
• Neurology
• Medical Devices

Background:

• Atrial fibrillation (AF) is a major cause of ischemic stroke, often undiagnosed in cryptogenic stroke and embolic stroke of undetermined source (ESUS) cases.
• Implantable cardiac monitors (ICMs) offer continuous rhythm monitoring for improved AF detection post-stroke or transient ischemic attack (TIA).

Purpose of the Study:

• To systematically review and meta-analyze the diagnostic yield, clinical impact, and safety of prolonged ICM monitoring in patients with ischemic stroke or TIA.
• To assess the effectiveness of ICMs in detecting AF and influencing treatment decisions.

Main Methods:

• Systematic review and meta-analysis following PRISMA 2020 guidelines, including randomized controlled trials and observational studies.
• Searches conducted in PubMed, Google Scholar, and Cochrane Library.
• Random-effects meta-analyses of observational studies for pooled AF detection, anticoagulation initiation, recurrent stroke rates, and adverse events.

Main Results:

• Twelve studies (4563 participants) were included; pooled AF detection rate was 25.9% (95% CI, 18.9-33.5%) with significant heterogeneity.
• Oral anticoagulation initiated in 94.2% (95% CI, 79.4-100.0%) of newly diagnosed AF patients.
• Device-related complications were rare (3.7%), and recurrent stroke/TIA occurred at 6.2%.

Conclusions:

• Prolonged ICM monitoring effectively identifies AF in a significant proportion of stroke/TIA patients, facilitating oral anticoagulation with a good safety profile.
• While ICMs enhance AF detection, current data is insufficient to prove a reduction in recurrent stroke.
• Larger randomized trials are necessary to confirm long-term clinical benefits and optimize ICM monitoring strategies.