LAUSR

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.