{"title":"Value of implantable loop recorders in detecting atrial fibrillation for stroke prevention: a systematic review and meta-analysis.","authors":"Mahrokh Janmohamadi, Amirreza Peyrovinasab, Seyedhesamoddin Khatami, Sepehr Moghaddam, Seyed Mohammad Forouzannia, Seyed Ali Forouzannia, Mohammadsadegh Faghihi, Arash Sarveazad, Seyedeh Romina Rafiei Alavi, Mostafa Hosseini, Mahmoud Yousefifard","doi":"10.1136/openhrt-2025-003456","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Though undiagnosed in many patients, especially those with cryptogenic stroke, atrial fibrillation (AF) is a key cause of ischaemic stroke. By allowing extended cardiac monitoring, implantable loop recorders (ILRs) may help enhance AF identification and secondary stroke prevention. Compared with standard therapy, this meta-analysis and systematic review assesses the effectiveness of ILRs in identifying AF and preventing recurrent stroke.</p><p><strong>Methods: </strong>We searched Web of Science, Scopus, Embase and PubMed up to September 2024 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Included were observational studies comparing ILR with conventional therapy in stroke or high-risk patients as well as randomised controlled trials (RCTs). AF detection, recurrent stroke and mortality were primary outcomes. Random-effects models were used to compute pooled HRs with 95% CIs. We looked at publication bias and heterogeneity.</p><p><strong>Results: </strong>Included were 12 studies with four RCTs and eight cohorts. Compared with controls, ILR use was linked to a much greater AF detection rate (HR=3.13, 95% CI 1.97 to 4.97). Embolic events fell insignificantly (HR=0.81, 95% CI 0.65 to 1.02) and mortality showed no change (HR=1.01, 95% CI 0.77 to 1.31). Subgroup analysis showed more AF detection in RCTs than in cohort studies (p=0.035). Although no major publishing bias was found, heterogeneity was considerable.</p><p><strong>Conclusion: </strong>By greatly enhancing AF detection in patients who had a stroke and at high risk, ILRs did not help to prevent secondary strokes. Therefore, they did not have enough efficacy in lowering recurrent stroke and death. Larger, more comprehensive studies are still required to clarify long-term therapeutic advantages and maximise patient selection.</p><p><strong>Prospero registration number: </strong>CRD420251051946.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8000,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Open Heart","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1136/openhrt-2025-003456","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
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Abstract
Background: Though undiagnosed in many patients, especially those with cryptogenic stroke, atrial fibrillation (AF) is a key cause of ischaemic stroke. By allowing extended cardiac monitoring, implantable loop recorders (ILRs) may help enhance AF identification and secondary stroke prevention. Compared with standard therapy, this meta-analysis and systematic review assesses the effectiveness of ILRs in identifying AF and preventing recurrent stroke.
Methods: We searched Web of Science, Scopus, Embase and PubMed up to September 2024 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Included were observational studies comparing ILR with conventional therapy in stroke or high-risk patients as well as randomised controlled trials (RCTs). AF detection, recurrent stroke and mortality were primary outcomes. Random-effects models were used to compute pooled HRs with 95% CIs. We looked at publication bias and heterogeneity.
Results: Included were 12 studies with four RCTs and eight cohorts. Compared with controls, ILR use was linked to a much greater AF detection rate (HR=3.13, 95% CI 1.97 to 4.97). Embolic events fell insignificantly (HR=0.81, 95% CI 0.65 to 1.02) and mortality showed no change (HR=1.01, 95% CI 0.77 to 1.31). Subgroup analysis showed more AF detection in RCTs than in cohort studies (p=0.035). Although no major publishing bias was found, heterogeneity was considerable.
Conclusion: By greatly enhancing AF detection in patients who had a stroke and at high risk, ILRs did not help to prevent secondary strokes. Therefore, they did not have enough efficacy in lowering recurrent stroke and death. Larger, more comprehensive studies are still required to clarify long-term therapeutic advantages and maximise patient selection.
背景：房颤（AF）是缺血性脑卒中的一个重要病因，但在许多患者，尤其是隐源性脑卒中患者中未被确诊。通过允许扩展心脏监测，植入式环路记录仪（ILRs）可能有助于增强AF识别和继发性卒中预防。与标准治疗相比，本荟萃分析和系统综述评估了ILRs在识别房颤和预防卒中复发方面的有效性。方法：我们按照首选报告项目检索Web of Science、Scopus、Embase和PubMed，检索截止到2024年9月的系统评价和meta分析建议。其中包括比较ILR与中风或高危患者常规治疗的观察性研究以及随机对照试验（rct）。房颤检测、卒中复发和死亡率是主要结局。随机效应模型用于计算95% ci的合并hr。我们研究了发表偏倚和异质性。结果：纳入12项研究，4项随机对照试验和8个队列。与对照组相比，ILR的使用与更高的AF检出率相关（HR=3.13, 95% CI 1.97至4.97）。栓塞事件下降不显著（HR=0.81, 95% CI 0.65 ~ 1.02），死亡率无变化（HR=1.01, 95% CI 0.77 ~ 1.31）。亚组分析显示，随机对照试验中房颤检出率高于队列研究（p=0.035）。虽然没有发现主要的发表偏倚，但异质性相当大。结论：通过大大提高卒中高危患者AF的检测，ILRs并不能帮助预防继发性卒中。因此，它们在降低卒中复发和死亡率方面没有足够的疗效。仍然需要更大规模、更全面的研究来阐明长期治疗优势并最大限度地选择患者。普洛斯彼罗注册号：CRD420251051946。
期刊介绍：
Open Heart is an online-only, open access cardiology journal that aims to be “open” in many ways: open access (free access for all readers), open peer review (unblinded peer review) and open data (data sharing is encouraged). The goal is to ensure maximum transparency and maximum impact on research progress and patient care. The journal is dedicated to publishing high quality, peer reviewed medical research in all disciplines and therapeutic areas of cardiovascular medicine. Research is published across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Opinionated discussions on controversial topics are welcomed. Open Heart aims to operate a fast submission and review process with continuous publication online, to ensure timely, up-to-date research is available worldwide. The journal adheres to a rigorous and transparent peer review process, and all articles go through a statistical assessment to ensure robustness of the analyses. Open Heart is an official journal of the British Cardiovascular Society.
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