TY - JOUR
TI - Prolonged Cardiac Monitoring and Stroke Recurrence: A Meta-analysis.
AU - Tsivgoulis, Georgios
AU - Triantafyllou, Sokratis
AU - Palaiodimou, Lina
AU - Grory, Brian Mac
AU - Deftereos, Spyridon
AU - Köhrmann, Martin
AU - Dilaveris, Polychronis
AU - Ricci, Brittany
AU - Tsioufis, Konstantinos
AU - Cutting, Shawna
AU - Magiorkinis, Gkikas
AU - Krogias, Christos
AU - Schellinger, Peter D.
AU - Dardiotis, Efthymios
AU - Rodriguez-Campello, Ana
AU - Cuadrado-Godia, Elisa
AU - Aguiar de Sousa, Diana
AU - Sharma, Mukul
AU - Gladstone, David J.
AU - Sanna, Tommaso
AU - Wachter, Rolf
AU - Furie, Karen L.
AU - Alexandrov, Andrei V.
AU - Yaghi, Shadi
AU - Katsanos, Aristeidis H.
JO - Functional Neurology
PY - 2022
VL - null
TODO - null
SP - 10.1212/WNL.0000000000200227
PB - 
SN - null
TODO - 10.1212/WNL.0000000000200227
TODO - null
TODO - 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.
ER -