Abstract WMP61: Predictors of Diagnostic Yield of Implanted Loop Recorder in Patients With Cryptogenic Stroke: a Systemic Review and Meta-analysis

• Published in: Stroke (1970) 2018-01, Vol.49 (Suppl_1)
• Main Authors: Bhatnagar, Udit B, Sethi, Prince, Gedela, Maheedhar, Thompson, Paul A, Pham, Roman, Pham, Scott
• Format: Article
• Language: English
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/str.49.suppl_1.WMP61

Abstract only Background: Implantable Loop Recorders (ILR) are increasingly being used for detection of atrial fibrillation (AF) after cryptogenic stroke (CS). There is limited data on determinants of diagnostic yield in this population. Objective: To systematically review prior available trials studying ILRs in CS to look for predictors of diagnostic yield of ILR over time. Methods: We searched MEDLINE and Cochrane Central Register of Controlled Trials. We included studies of ILRs on patients who presented with acute CS. We excluded studies which did not analyze baseline characteristics of patients with and without AF detection. Results: Our search revealed six prospective studies which met inclusion criteria with a total of 344 patients. All patients had at least 24 hour ambulatory EKG prior to ILR implantation. The mean duration of ILR monitoring was 445.2 days. On an average 24.4% of patients had new AF detected with an average time to detection of 85.5 days. Table 1 shows summary statistics and meta-analysis combinations of studies. Comparing covariates among patients with and without AF detection, a basic combination of individual study p-values (Z score) revealed age, CHADS-Vasc score, left atrial (LA) volume and ectopy to be significantly different in the two groups. Analyzing significance with χ 2 combination methods and combinations of effect size values suggested only CHADS-Vasc score to be significant. Ectopy was presented in terms of burden of APCs in two studies which showed significant difference between groups; and in terms of proportions of cases with “excessive” atrial ectopy in two other studies which did not show significance. Conclusions: Overall AF was detected in 24.4% of patients with ILR implantation after CS. CHADS-Vasc score was found to be a significant predictor in detecting AF. Older age, increased LA volumes and excessive ectopy on holter were found to be significant in some studies but on overall computation did not show statistical significance.