Cardiac monitoring for detection of atrial fibrillation after TIA: A systematic review and meta-analysis.
Background and purpose The detection rate of atrial fibrillation has not been studied specifically in transient ischemic attack (TIA) patients although extrapolation from ischemic stroke may be inadequate. We conducted a systematic review and meta-analysis to determine the rate of newly diagnosed atrial fibrillation using different methods of ECG monitoring in TIA. Methods A comprehensive literature search was performed following a pre-specified protocol the PRISMA statement. Prospective observational studies and randomized controlled trials were considered that included TIA patients who underwent cardiac monitoring for >12 h. Primary outcome was frequency of detection of atrial fibrillation ≥30 s. Analyses of subgroups and of duration and type of monitoring were performed. Results Seventeen studies enrolling 1163 patients were included. The pooled atrial fibrillation detection rate for all methods was 4% (95% CI: 2-7%). Yield of monitoring was higher in selected (higher age, more extensive testing for arrhythmias before enrolment, or presumed cardioembolic/cryptogenic cause) than in unselected cohorts (7% vs 3%). Pooled mean atrial fibrillation detection rates rose with duration of monitoring: 4% (24 h), 5% (24 h to 7 days) and 6% (>7 days), respectively. Yield of non-invasive was significantly lower than that of invasive monitoring (4% vs. 11%). Significant heterogeneity was observed among studies (I2=60.61%). Conclusion This first meta-analysis of atrial fibrillation detection in TIA patients finds a lower atrial fibrillation detection rate in TIA than reported for IS and TIA cohorts in previous meta-analyses. Prospective studies are needed to determine actual prevalence of atrial fibrillation and optimal diagnostic procedure for atrial fibrillation detection in TIA.
1 Division of Brain Sciences, Department of Stroke Medicine, Imperial College, London, UK.
Eleni
E
Korompoki
1 Division of Brain Sciences, Department of Stroke Medicine, Imperial College, London, UK.
Angela
A
Del Giudice
2 Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.
Steffi
S
Hillmann
2 Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.|3 Clinical Trial Center, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany.
Uwe
U
Malzahn
4 Division of Neurology, Department of Medicine, University Toronto, Ontario, Canada.
David J
DJ
Gladstone
2 Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.|3 Clinical Trial Center, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany.
Peter
P
Heuschmann
1 Division of Brain Sciences, Department of Stroke Medicine, Imperial College, London, UK.
Roland
R
Veltkamp
D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000209:etiology; D004562:Electrocardiography; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications*; D008991:Monitoring, Physiologic; D020521:Stroke / Q000150:complications
Ischemic attack; atrial fibrillation; electrophysiology; transient