title: Prolonged Cardiac Monitoring to Detect Atrial Fibrillation after Cryptogenic Stroke or Transient Ischemic Attack: A Meta-Analysis of Randomized Controlled Trials.
abstract: BACKGROUND
  The cause of ischemic stroke or transient ischemic attack (TIA) remains unclear after initial cardiac monitoring in approximately one-third of patients. Randomized controlled trials (RCTs) showed that the prolonged cardiac monitoring of patients with cryptogenic stroke or TIA increased detection of atrial fibrillation (AF). We aimed to perform a meta-analysis of all RCTs that evaluated the prolonged monitoring ≥7 days in patients with cryptogenic stroke or TIA.
  
  
  METHODS
  We searched PubMed, EMBASE, Cochrane CENTRAL, and relevant references for RCTs without language restriction (inception through December 2014) and performed meta-analysis using random effects model. Detection of AF, use of anticoagulation at follow-up, recurrent stroke or TIA, and mortality were major outcomes.
  
  
  RESULTS
  Four RCTs with 1149 total patients were included in the meta-analysis. Prolonged cardiac monitoring ≥7 days compared to shorter cardiac monitoring of ≤48 hours duration increased the detection of AF (≥30 seconds duration) in patients after cryptogenic stroke or TIA (13.8% vs. 2.5%; odds ratio [OR], 6.4; 95% confidence interval [CI], 3.50-11.73; P < 0.00001; I(2) , 0%]. It also increased the odds of AF detection of any duration (22.6% vs. 5.2%; 5.68[3.3-9.77]; P < 0.00001; I(2) , 0%). The patients who underwent prolonged monitoring were more likely to be on anticoagulation at follow-up (2.21[1.52-3.21]; P < 0.0001; I(2) , 0%). No differences in recurrent stroke or TIA (0.78[0.40-1.55]; P = 0.48; I(2) , 0%) and mortality (1.33[0.29-6.00]; P = 0.71; I(2) , 0%] were observed between two strategies.
  
  
  CONCLUSIONS
  Prolonged cardiac monitoring improves detection of atrial fibrillation and anti-coagulation use after cryptogenic stroke or TIA and therefore should be considered instead of shorter duration of cardiac monitoring.
authors.affiliation: Department of Medicine, LRG Healthcare, Laconia, NH.
authors.forename: Khagendra
authors.initials: K
authors.lastname: Dahal
authors.affiliation: Department of Medicine, LRG Healthcare, Laconia, NH.
authors.forename: Bikas
authors.initials: B
authors.lastname: Chapagain
authors.affiliation: Division of Neurology, Nanticoke Memorial Hospital, Seaford, DE.
authors.forename: Raju
authors.initials: R
authors.lastname: Maharjan
authors.affiliation: Concord Cardiac Associates, Dartmouth Hitchcock Medical Clinic, Concord, NH.
authors.forename: Hussam W
authors.initials: HW
authors.lastname: Farah
authors.affiliation: Concord Cardiac Associates, Dartmouth Hitchcock Medical Clinic, Concord, NH.
authors.forename: Ayesha
authors.initials: A
authors.lastname: Nazeer
authors.affiliation: Concord Cardiac Associates, Dartmouth Hitchcock Medical Clinic, Concord, NH.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lootens
authors.affiliation: Concord Cardiac Associates, Dartmouth Hitchcock Medical Clinic, Concord, NH.
authors.forename: Alan
authors.initials: A
authors.lastname: Rosenfeld
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D008991:Monitoring, Physiologic / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality
chemical_list: D000925:Anticoagulants
keywords: TIA; atrial fibrillation; cardiac monitor; meta-analysis; stroke