ESOC 2026 | Systematic review and meta-analysis of cardiac monitoring for the detection of AF after TIA
Alexander Veltkamp, MD, Alfried Krupp Krankenhaus, Essen, Germany, discusses a systematic review and meta-analysis of cardiac monitoring for the detection of atrial fibrillation (AF) after transient ischemic attack (TIA). Dr Veltkamp shares the results showing that the pooled AF detection rate in TIA patients is 6.5% and increases with monitoring duration, with implantable cardiac monitors detecting more AF than non-invasive monitoring. This interview took place at the 12th European Stroke Organisation Conference (ESOC) in Maastricht, The Netherlands.
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Transcript
Evidence is mainly taken from mixed stroke TIA trials and the optimal monitoring strategy for TIA patients to detect atrial fibrillation is unclear at the moment. The purpose of this systematic review was to determine the rate of newly diagnosed atrial fibrillation greater than 30 seconds in TIA patients using different continuous cardiac monitoring durations and modalities. Results of our systematic review meta-analysis are that we included 42 studies with 50 monitoring cohorts including 3981 TIA patients...
Evidence is mainly taken from mixed stroke TIA trials and the optimal monitoring strategy for TIA patients to detect atrial fibrillation is unclear at the moment. The purpose of this systematic review was to determine the rate of newly diagnosed atrial fibrillation greater than 30 seconds in TIA patients using different continuous cardiac monitoring durations and modalities. Results of our systematic review meta-analysis are that we included 42 studies with 50 monitoring cohorts including 3981 TIA patients. There are four key results. First, the pooled AF detection rate in TIA patients is 6.5%. Second, the AF detection rate increases with monitoring duration. For example, at 30 days, the AF detection rate is around 9.6%. And at one year or 12 months, the AF detection rate is at 19.1%. Third result, implantable cardiac monitors detect more atrial fibrillation after TIA compared to non-invasive monitoring, namely 20.8% versus 4.7%. And fourth, in exploratory analysis of ischemic event rates, we found an event rate of 4.9 per 100 patient years during follow-up. Strengths of our systematic review include that this is the largest TIA-specific systematic review for AF detection, including 435 TIA patients with invasive monitoring. And limitations include that this is only an aggregate data meta-analysis and not adjusted for individual level confounders. And overall, in the studies included, there’s high heterogeneity in definitions of TIA, in definitions of atrial fibrillation, monitoring methods and monitoring duration, and also follow-up. To conclude, this meta-analysis found high rates of newly detected AF using prolonged cardiac monitoring in TIA patients, studies using implantable cardiac monitoring, specifically in TIA patients, are still rare, and randomized controlled trials are needed for head-to-head comparison of different monitoring strategies, durations, and to determine whether prolonged cardiac monitoring improves clinical outcome in TIA patients. And at this point, I’d like to refer to the late-breaking trial session this Friday morning, where the results of the ODEA-TIA trial will be presented. Thank you.
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