Detecting AFib in Stroke Patients With Large or Small Vessel Disease

October 6, 2016
Dava Stewart

The aim of the present meta-analysis was “to estimate the yield of AF detection in patients with stroke due to small and large vessel disease and in stroke patients in whom stroke etiology was not defined,” say the researchers.

A recent meta-analysis found that the rate of detection of atrial fibrillation (AF) is similar among patients with small and large vessel strokes. However, researchers were unable to determine the utility of long-term cardiac monitoring due to a lack of controlled trials. The analysis was conducted by Jelle Demeestere, MD, of the Department of Neurology at the University Hospitals Leuven, in Belgium, and colleagues, and was published in the Journal of the American Heart Association on September 26, 2016.

Although “randomized controlled trials in cryptogenic stroke patients have shown increased rates of AF detection with long term monitoring,” say the authors, “the prevalence of AF in patients with small or large vessel strokes is far less studied.” The aim of the present meta-analysis was “to estimate the yield of AF detection in patients with stroke due to small and large vessel disease and in stroke patients in whom stroke etiology was not defined,” say the researchers.

The analysis included a total of 30 studies, all of which were cohort studies; 20 were prospective in design, and the remaining 10 were retrospective. The researchers reported finding “considerable between-study heterogeneity,” they said, and so “performed an exploratory analysis for factors accountable for this between-study heterogeneity.” Inclusion of transient ischemic attack (TIA) patients accounted for 29.4% of the between-study heterogeneity. However, “correction for inclusion of TIA patients in the study population did not alter the result” of the meta-analysis, said the researchers.

The main finding of this meta-analysis, say the authors is “that the yield of AF detection with relatively short duration ambulatory cardiac monitoring is ~2% to 2.5% in patients with small and large vessel disease strokes.” They add that, in studies that did not define stroke etiology the rate of AF detection was 9.3%, which is similar to rates reported in studies that include only cryptogenic stroke patients.

The researchers conclude by recommending that “clinical trials are needed to determine the yield of AF detection with long-term monitoring in this population.” Such trials could provide information about “the rate of stroke recurrence the effect of anticoagulation on stroke recurrence among patients with presumed small or large vessel disease stroke who are diagnosed with AF, and the cost-effectiveness of long-term cardiac monitoring in this specific population,” say the authors.

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