Electrocardiographic Monitoring for Detecting Atrial Fibrillation After Ischemic Stroke or Transient Ischemic Attack

Abstract

Background-Atrial fibrillation (AF) is a major cause of stroke. Although standard investigations after an event include electrocardiographic monitoring, the optimal duration to detect AF is unclear. We performed a systematic review and meta-analysis to determine whether the duration of electrocardiographic monitoring after an ischemic event is related to the detection of AF. Methods and Results-Prospective studies that reported the proportion of new AF diagnosed using electrocardiographic monitoring for >12 hours in patients with recent stroke or transient ischemic attack were analyzed. Studies were excluded if the stroke was hemorrhagic or AF was previously diagnosed. A total of 31 articles met inclusion criteria. Longer duration of monitoring was associated with an increased detection of AF when examining monitoring time as a continuous variable (P<0.001 for metaregression analysis). When dichotomizing studies based on monitoring duration, studies with monitoring lasting ≤72 hours detected AF in 5.1%, whereas monitoring lasting ≥7 days detected AF in 15%.The proportion of new diagnosis increased to 29.15% with extended monitoring for 3 months. Significant heterogeneity within studies was detected for both groups (≤72 hours, I 2 =91.3%; ≥7 days, I 2 =75.8). When assessing the odds of AF detection in the 3 randomized controlled trial, there was a 7.26 increased odds of AF with long-term monitoring (95% confidence intervals [3.99-12.83]; P value <0.001). Conclusions-Longer duration of electrocardiographic monitoring after cryptogenic stroke is associated with a greater detection of AF. Future investigation is needed to determine the optimal duration of long-term monitoring.

Detection and management of atrial fibrillation after cryptogenic stroke or embolic stroke of undetermined source

“…Several monitoring strategies have been investigated to detect asymptomatic AF after an ischemic stroke, including electrocardiography (ECG), in-hospital monitoring, Holter ECG of variable duration, external event or loop recorders, mobile cardiac outpatient telemetry, and implantable cardiac monitors. These studies, and their recent meta-analyses, [7][8][9][10][11][12] contributed significantly to our current understanding of the incidence of AF after ischemic stroke.…”

Paroxysmal Atrial Fibrillation: Novel Strategies for Monitoring and Implications for Treatment in Stroke

“…The 2014 AHA/ASA stroke prevention guidelines recommend 30 days of cardiac monitoring for patients with cryptogenic stroke or TIA when performed within 6 months of the event (class IIa; level of evidence C) [5]. The available literature and several recent meta-analyses clearly demonstrate that longer cardiac monitoring results in greater atrial fibrillation detection [3,46,47]. This is demonstrated nicely in the SMART registry, where 45 % of new AF occurred in the first 10 days of monitoring, 31 % in the next 10 days, and 24 % in the last 10 days [25].…”

An Anonymous Mutual Authenticated Key Agreement Scheme for Wearable Sensors in Wireless Body Area Networks

“…Integration of WBAN with modern cloud and sensor technologies offers huge improvement in the efficiency and functionality of medical and health care systems. For instance, after the ischemic stroke, patients would require a long-term electrocardiographic monitoring [1]. They suffer from the sleep apnea, and, consequently, require to wear a portable monitor while sleeping [2].…”