title: Role of Outpatient Cardiac Rhythm Monitoring in Cryptogenic Stroke: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Recent studies have suggested that prolonged outpatient rhythm monitoring results in increased detection of atrial fibrillation (AF) in patients with cryptogenic stroke (CS). However, the best monitoring strategy and its clinical utility is debatable.
  
  
  OBJECTIVE
  To compare the effectiveness of implantable loop recorder (ILR) versus wearable devices in identifying AF in patients with CS.
  
  
  RESULTS
  Three randomized controlled trials (RCTs) and 13 observational studies were identified by database searches. Seven studies (enrolling 774 patients) employed ILR for AF detection for a median duration of 365 days (range 50-569 days). Ten studies (enrolling 996 patients) employed continuous monitoring with wearable devices for a median duration of 21 days (range 4-30 days). One study performed 7 days of monitoring with wearable device followed by implantation of ILR, thus included in both groups. Pooled odds ratio (OR) of identifying AF in RCTs showed increased detection of AF with prolonged monitoring (OR 4.54, 95% confidence interval [CI] 2.92, 7.06; P < 0.00001) compared to routine outpatient follow-up. Overall detection of AF with outpatient monitoring was 17.6% (CI: 12.5-22.7). There was significantly higher AF detection with ILR (23.3%; CI: 13.83-32.29) compared to wearable devices (13.6%; CI: 7.91-19.32; P < 0.05). Patients with AF were older in age compared to patients without AF.
  
  
  CONCLUSIONS
  AF detection in patients with CS is improved with prolonged rhythm monitoring and is better with ILR compared to wearable devices. AF was more common in older patients. The clinical significance of these findings is unknown at this point.
authors.affiliation: From the Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas.
authors.forename: Muhammad R
authors.initials: MR
authors.lastname: Afzal
authors.affiliation: From the Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas.
authors.forename: Sampath
authors.initials: S
authors.lastname: Gunda
authors.affiliation: From the Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas.
authors.forename: Salman
authors.initials: S
authors.lastname: Waheed
authors.affiliation: From the Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas.
authors.forename: Nandhini
authors.initials: N
authors.lastname: Sehar
authors.affiliation: From the Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Maybrook
authors.affiliation: From the Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas.
authors.forename: Buddhadeb
authors.initials: B
authors.lastname: Dawn
authors.affiliation: From the Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas.
authors.forename: Dhanunjaya
authors.initials: D
authors.lastname: Lakkireddy
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology*; D015984:Causality; D015897:Comorbidity; D015716:Electrocardiography, Ambulatory / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology*; D015996:Survival Rate
keywords: atrial fibrillation; cryptogenic stroke; implantable loop recorder; outpatient rhythm monitoring