@article{3203339,
    title = "Prolonged Cardiac Monitoring and Stroke Recurrence: A Meta-analysis.",
    author = "Tsivgoulis, Georgios and Triantafyllou, Sokratis and Palaiodimou, Lina and Grory, Brian Mac and Deftereos, Spyridon and Köhrmann, Martin and Dilaveris, Polychronis and Ricci, Brittany and Tsioufis, Konstantinos and Cutting, Shawna and Magiorkinis, Gkikas and Krogias, Christos and Schellinger, Peter D. and Dardiotis, Efthymios and Rodriguez-Campello, Ana and Cuadrado-Godia, Elisa and Aguiar de Sousa, Diana and Sharma, Mukul and Gladstone, David J. and Sanna, Tommaso and Wachter, Rolf and Furie, Karen L. and Alexandrov, Andrei V. and Yaghi, Shadi and Katsanos, Aristeidis H.",
    journal = "Functional Neurology",
    year = "2022",
    pages = "10.1212/WNL.0000000000200227",
    doi = "10.1212/WNL.0000000000200227",
    abstract = "OBJECTIVE: Prolonged post-stroke cardiac rhythm monitoring (PCM) reveals a substantial proportion of ischemic stroke (IS) patients with atrial fibrillation  (AF) not detected by conventional rhythm monitoring strategies. We aim to evaluate  the association between PCM and the institution of stroke preventive strategies and  stroke recurrence. METHODS: We searched MEDLINE and SCOPUS databases to identify  studies reporting stroke recurrence rates in patients with history of recent IS or  transient ischemic attack (TIA) receiving PCM compared with patients receiving  conventional cardiac rhythm monitoring. Pairwise meta-analyses were performed under  the random-effects model. To explore for differences between the monitoring  strategies we combined direct and indirect evidence for any given pair of monitoring  devices assessed within a randomized controlled trial (RCT). RESULTS: We included 8  studies (5 RCTs, 3 observational; 2994 patients). Patients receiving PCM after their  index event had a higher rate of AF detection and anticoagulant initiation in both  RCTs (RR=3.91, 95%CI:2.54-6.03 & RR=2.16, 95%CI:1.66-2.80) and observational studies  (RR=2.06, 95%CI:1.57-2.70 & RR=2.01; 95%CI:1.43-2.83), respectively. PCM was  associated with a lower risk of recurrent stroke during follow-up in observational  studies (RR=0.29; 95%CI:0.15-0.59), but not in RCTs (RR=0.72, 95%CI:0.49-1.07). In  the indirect analyses of RCTs the likelihood of AF detection and anticoagulation  initiation was higher for implantable loop recorders compared with both Holter  monitors and external loop recorders. CONCLUSIONS: PCM after an IS or TIA can lead  to higher rates of AF detection and anticoagulant initiation. Currently, there is no  solid RCT evidence supporting that PCM may be associated with lower stroke  recurrence risk."
}