Effect of implantable cardiac monitors on preventing stroke: A systematic review and meta-analysis of randomized clinical trials.

Abstract

BACKGROUND AND AIM:

Implantable cardiac monitors (ICM) can facilitate the detection of asymptomatic atrial fibrillation episodes. We performed a systematic review and meta-analysis to investigate whether ICM can prevent stroke in patients with prior stroke and risk factors for stroke.

METHODS:

This study included randomized controlled trials comparing ICM with conventional (non-ICM) external cardiac monitoring in patients with prior stroke and risk factors for stroke. We searched Medline, Embase, and CENTRAL from inception until January 5, 2022, without language restriction. Quantitative pooling of the data was undertaken using a random-effects model. The primary outcome was ischemic stroke at the longest follow-up.

RESULTS:

Four trials comprising 7237 patients were included. ICM was significantly associated with decreased risk of ischemic stroke (RR 0.76; 95% CI, 0.59-0.97; moderate-quality evidence) in patients with prior stroke and risk factors for stroke. ICM was associated with higher detection of atrial fibrillation (RR 4.21, 95% CI 2.26-7.85) and use of oral anticoagulants (RR 2.29, 95% CI 2.07-2.55).

CONCLUSIONS:

ICM results in a significantly lower risk of ischemic stroke than conventional (non-ICM) external cardiac monitoring in patients with prior stroke and risk factors for stroke. Due to the clinical heterogeneity of study population and limited related studies, more trials were needed to furtherly explore the topic in patients with prior stroke or high risk of stroke.

• Authors: Jialing He, Yaxin Jiang, Yangchun Xiao, Pengfei Hao, Tiangui Li, Liyuan Peng, Yuning Feng, Xin Cheng, Haidong Deng, Peng Wang, Weelic Chong, Yang Hai, Lvlin Chen, Chao You, Lu Jia, Fang Fang, Shui Yu, Yu Zhang
• Journal: PloS one (PLoS One) Vol. 18 Issue 7 Pg. e0287318 ( 2023) ISSN: 1932-6203 [Electronic] United States
• PMID: 37471323 (Publication Type: Meta-Analysis, Systematic Review, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright: © 2023 He et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Chemical References

• Anticoagulants

Topics

• Humans
• Atrial Fibrillation (complications, diagnosis, drug therapy)
• Randomized Controlled Trials as Topic
• Stroke (diagnosis, prevention & control, drug therapy)
• Electrocardiography
• Anticoagulants (therapeutic use)
• Ischemic Stroke (drug therapy)