Jesse DawsonAIMAN AHMED IBRAHIM HAKAMI2022-05-302022-05-30https://drepo.sdl.edu.sa/handle/20.500.14154/50266Stroke is a disabling and burdensome cerebrovascular event, with cases exceeding 14 million per year and accounting for more than 120 million disability-adjusted life-years. Atrial fibrillation is a major cause of ischaemic stroke worldwide, and detection of this arrhythmia is key to guiding secondary prevention. However, the problem is often missed due to the paroxysmal nature of the arrhythmia and the suboptimal sensitivity of 24-hour and 30-day electrocardiography. Therefore, this systematic review and meta-analysis sought to investigate the diagnostic value of implantable cardiac monitors for detection of atrial fibrillation among survivors of ischaemic and cryptogenic stroke. Three databases—MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL)—were searched in August 2021 using key terms and precision-optimising operations. Articles were limited to observational design, use of the English language, and publication in or after 2011. Observational studies have been chosen in this systematic review and meta-analysis to see if the detection rates in trials appear true in routine clinical practice. The studies were critically appraised using the Cochrane ROBINS-I tool, and the data concerning the utility of implantable cardiac devices were pooled and meta-analysed using RevMan v5.3. Fifteen studies were eligible: 10 with prospective cohorts and 5 with retrospective cohorts. The risk of bias tended to be low for most systematic biases of observational studies. The mean detection rate for atrial fibrillation was 24.08% (95% CI 19.70, 28.47; Z = 10.76, p<0.00001). Excess interstudy heterogeneity was not present (I2=0%, p=0.52). The mean time to detection of atrial fibrillation was 91.87 days (95% CI 72.08, 111.66; Z = 9.10, p<0.00001); but heterogeneity affected certainty in this outcome (I2=95, p<0.00001). Finally, the mean duration of atrial fibrillation episodes captured was 91.88 minutes (95% CI 25.10, 158.65; Z = 2.70, p=0.007); but certainty was compounded by heterogeneity (I2=99%, p<0.00001). This review also found that increased age, greater CHA2DS2-VASc scores, electrophysiological aberrations of the left atria, and diastolic dysfunction influenced detection rates for atrial fibrillation. In light of desirable methodological quality, the evidence should be used to guide ongoing practice regard the secondary prevention of stroke in persons following incident ischaemic or cryptogenic stroke.en