Please use this identifier to cite or link to this item: https://hdl.handle.net/10356/164491
Title: A meta-analysis of extended ECG monitoring in detection of atrial fibrillation in patients with cryptogenic stroke
Authors: Jiang, Haowen
Tan, Shyn Yi
Wang, Jeremy King
Li, Jiaqi
Tu, Tian Ming
Tan, Vern Hsen
Yeo, Colin
Keywords: Science::Medicine
Issue Date: 2022
Source: Jiang, H., Tan, S. Y., Wang, J. K., Li, J., Tu, T. M., Tan, V. H. & Yeo, C. (2022). A meta-analysis of extended ECG monitoring in detection of atrial fibrillation in patients with cryptogenic stroke. Open Heart, 9(2), e002081-. https://dx.doi.org/10.1136/openhrt-2022-002081
Journal: Open Heart 
Abstract: Objective: The aim of this systematic review is to evaluate the various modalities available for extended ECG monitoring in the detection of atrial fibrillation (AF) following a cryptogenic stroke. Methods: MEDLINE (Ovid), EMBASE (Ovid), Cochrane Central Register of Controlled Trials (CENTRAL) were searched from January 2011 to November 2021. All randomised controlled trials and prospective cohort studies including the use of extended ECG monitoring >24 hours with a minimum duration of AF of 30 s in patients with either cryptogenic strokes or transient ischaemic attacks were included. A random-effects model was used to pool effect estimates of AF detection rates from different ECG modalities. Results: 3924 studies were identified, of which 47 were included reporting on a pooled population of 6448 patients with cryptogenic stroke. The pooled AF rate for implantable loop recorders (ILRs) increased from 4.9% (3.0%-7.9%) at 1 month to 38.4% (20.4%-60.2%) at 36 months. Mobile cardiac outpatient telemetry (MCOT) had a significantly higher pooled AF detection rate of 12.8% (8.9%-17.9%) versus 4.9% (3.0%-7.9%) for ILR at 1 month (p<0.0001). Predictors for AF detection include duration of monitoring (p<0.0001) and age (p<0.0001) for ILRs, but only age for MCOTs (p<0.020). Conclusion: MCOT has a higher rate of detection at 1 month and is less invasive. Beyond 1 month, compliance becomes a significant limitation for MCOT. MCOT may be a reasonable alternative AF screening tool for patients with cryptogenic stroke if ILR is not available. PROSPERO registration number CRD42022297782.
URI: https://hdl.handle.net/10356/164491
ISSN: 2053-3624
DOI: 10.1136/openhrt-2022-002081
Schools: Lee Kong Chian School of Medicine (LKCMedicine) 
Rights: © Author(s) (or their employer(s)) 2022. Open access. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Fulltext Permission: open
Fulltext Availability: With Fulltext
Appears in Collections:LKCMedicine Journal Articles

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