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The efficacy and safety of insertable cardiac monitor on atrial fibrillation detection in patients with ischemic stroke: a systematic review and meta-analysis

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Abstract

Atrial fibrillation (AF) leads to a high risk of recurrent stroke, and the insertable cardiac monitor (ICM), as a new kind of electrocardiographic monitoring device, has been proven to enhance the recognition rate of AF. The aim of this systematic review was to evaluate the efficacy and safety of the ICM use in AF detection of patients with stroke. We pooled 1233 patients from three randomized controlled trials (RCTs). The detection rate of AF was superior in the ICM group to that in the control group at 6 months (risk ratio [RR], 4.63; P < 0.0001; 95% confidence interval [CI], 2.17–9.90) and 12 months (RR, 5.04; P < 0.00001; 95% CI, 2.93 to 8.68). Patients in the ICM group had a higher rate of oral anticoagulant usage (RR, 2.76; P < 0.00001; 95% CI, 1.89–4.02). However, there was no difference in the time to first detection of AF within 12 months (mean difference, − 8.28; P = 0.82; 95% CI, − 77.84–61.28) or the rate of recurrent ischemic stroke or transient ischemic attack (RR, 0.88; P = 0.51; 95% CI, 0.60–1.28) between the ICM and control groups. In addition, the ICM group experienced more adverse events than the control group within 12 months (RR, 4.42; P = 0.002; 95% CI, 1.69–11.55). To conclude, the sensitivity of ICM is superior to that of conventional external cardiac monitoring. Reducing adverse reactions will be a new development direction of ICM.

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All data generated or analyzed during this study are included in this published article and its supplementary information files.

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Funding

This work was supported by the Suzhou Health Talents Training Project (GSWS2019002).

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Author notes

  1. Xin Tan, Zilan Wang and Xin Wu contribute equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China

    Xin Tan, Zilan Wang, Xin Wu, Jie Zhang, Zhaoming Song, Youjia Qiu, Zhouqing Chen, Zhong Wang & Gang Chen

  2. Department of Neurology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, 215002, Jiangsu Province, China

    Xin Tan

  3. Department of Neurosurgery, Suzhou Ninth People’s Hospital, Suzhou, 215200, Jiangsu Province, China

    Xin Wu

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  1. Xin Tan
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Contributions

XT and ZLW was the principal investigator. XT and XW designed the study and developed the analysis plan. XW, XT and JZ analyzed the data and performed meta-analysis. TX and ZLW contributed in writing of the article. ZMS and YJQ revised the manuscript and polish the language. ZQC, ZW and GC supervised the project. All authors read and approved the final submitted paper.

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Correspondence to Zhouqing Chen or Zhong Wang.

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Tan, X., Wang, Z., Wu, X. et al. The efficacy and safety of insertable cardiac monitor on atrial fibrillation detection in patients with ischemic stroke: a systematic review and meta-analysis. J Neurol 269, 2338–2345 (2022). https://doi.org/10.1007/s00415-021-10903-0

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