title: Electrocardiographic monitoring for detecting atrial fibrillation after ischemic stroke or transient ischemic attack: systematic review and meta-analysis.
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.
  
  
  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) =7 5.8). 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.
authors: From the Division of Cardiac Electrophysiology, Department of Medicine, Sherbrooke University, Quebec, Canada (C.D., J.-F.R.); Division of Cardiac Surgery, Department of Surgery, University of Ottawa Heart Institute, Ontario, Canada (H.T.); Department of Cardiac Surgery, Boston Children's Hospital, MA (M.N.); Division of Cardiac Surgery, Anzhen Hospital, Department of Surgery, Capital Medical University, Beijing, China (Z.J.W.); and Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston (E.S.). charles.dussault@usherbrooke.ca.
authors: Charles
authors: C
authors: Dussault
authors: From the Division of Cardiac Electrophysiology, Department of Medicine, Sherbrooke University, Quebec, Canada (C.D., J.-F.R.); Division of Cardiac Surgery, Department of Surgery, University of Ottawa Heart Institute, Ontario, Canada (H.T.); Department of Cardiac Surgery, Boston Children's Hospital, MA (M.N.); Division of Cardiac Surgery, Anzhen Hospital, Department of Surgery, Capital Medical University, Beijing, China (Z.J.W.); and Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston (E.S.).
authors: Hadi
authors: H
authors: Toeg
authors: From the Division of Cardiac Electrophysiology, Department of Medicine, Sherbrooke University, Quebec, Canada (C.D., J.-F.R.); Division of Cardiac Surgery, Department of Surgery, University of Ottawa Heart Institute, Ontario, Canada (H.T.); Department of Cardiac Surgery, Boston Children's Hospital, MA (M.N.); Division of Cardiac Surgery, Anzhen Hospital, Department of Surgery, Capital Medical University, Beijing, China (Z.J.W.); and Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston (E.S.).
authors: Meena
authors: M
authors: Nathan
authors: From the Division of Cardiac Electrophysiology, Department of Medicine, Sherbrooke University, Quebec, Canada (C.D., J.-F.R.); Division of Cardiac Surgery, Department of Surgery, University of Ottawa Heart Institute, Ontario, Canada (H.T.); Department of Cardiac Surgery, Boston Children's Hospital, MA (M.N.); Division of Cardiac Surgery, Anzhen Hospital, Department of Surgery, Capital Medical University, Beijing, China (Z.J.W.); and Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston (E.S.).
authors: Zhi Jian
authors: ZJ
authors: Wang
authors: From the Division of Cardiac Electrophysiology, Department of Medicine, Sherbrooke University, Quebec, Canada (C.D., J.-F.R.); Division of Cardiac Surgery, Department of Surgery, University of Ottawa Heart Institute, Ontario, Canada (H.T.); Department of Cardiac Surgery, Boston Children's Hospital, MA (M.N.); Division of Cardiac Surgery, Anzhen Hospital, Department of Surgery, Capital Medical University, Beijing, China (Z.J.W.); and Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston (E.S.).
authors: Jean-Francois
authors: JF
authors: Roux
authors: From the Division of Cardiac Electrophysiology, Department of Medicine, Sherbrooke University, Quebec, Canada (C.D., J.-F.R.); Division of Cardiac Surgery, Department of Surgery, University of Ottawa Heart Institute, Ontario, Canada (H.T.); Department of Cardiac Surgery, Boston Children's Hospital, MA (M.N.); Division of Cardiac Surgery, Anzhen Hospital, Department of Surgery, Capital Medical University, Beijing, China (Z.J.W.); and Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston (E.S.).
authors: Eric
authors: E
authors: Secemsky
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D004562:Electrocardiography; D006339:Heart Rate; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D013997:Time Factors
keywords: atrial fibrillation; electrocardiography; meta-analysis; stroke