Use of wearable technology in cardiac monitoring after cryptogenic stroke or embolic stroke of undetermined source: a systematic review
Introduction: Prolonged cardiac monitoring after cryptogenic stroke or embolic stroke of undetermined source (ESUS) is necessary to identify atrial fibrillation (AF) that requires anticoagulation. Wearable devices may improve AF detection compared to conventional management. We aimed to review the e...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer – Medknow Publications
2024-07-01
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| Series: | Singapore Medical Journal |
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| Online Access: | https://journals.lww.com/10.4103/singaporemedj.SMJ-2022-143 |
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| _version_ | 1823863742515904512 |
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| author | Jamie SY Ho Elizabeth SY Ho Leonard LL Yeo William KF Kong Tony YW Li Benjamin YQ Tan Mark Y Chan Vijay K Sharma Kian-Keong Poh Ching-Hui Sia |
| author_facet | Jamie SY Ho Elizabeth SY Ho Leonard LL Yeo William KF Kong Tony YW Li Benjamin YQ Tan Mark Y Chan Vijay K Sharma Kian-Keong Poh Ching-Hui Sia |
| author_sort | Jamie SY Ho |
| collection | DOAJ |
| description | Introduction:
Prolonged cardiac monitoring after cryptogenic stroke or embolic stroke of undetermined source (ESUS) is necessary to identify atrial fibrillation (AF) that requires anticoagulation. Wearable devices may improve AF detection compared to conventional management. We aimed to review the evidence for the use of wearable devices in post-cryptogenic stroke and post-ESUS monitoring.
Methods:
We performed a systematic search of PubMed, EMBASE, Scopus and clinicaltrials.gov on 21 July 2022, identifying all studies that investigated the use of wearable devices in patients with cryptogenic stroke or ESUS. The outcomes of AF detection were analysed. Literature reports on electrocardiogram (ECG)-based (external wearable, handheld, patch, mobile cardiac telemetry [MCT], smartwatch) and photoplethysmography (PPG)-based (smartwatch, smartphone) devices were summarised.
Results:
A total of 27 relevant studies were included (two randomised controlled trials, seven prospective trials, 10 cohort studies, six case series and two case reports). Only four studies compared wearable technology to Holter monitoring or implantable loop recorder, and these studies showed no significant differences on meta-analysis (odds ratio 2.35, 95% confidence interval [CI] 0.74–7.48, I2 = 70%). External wearable devices detected AF in 20.7% (95% CI 14.9–27.2, I2 = 76%) of patients and MCT detected new AF in 9.6% (95% CI 7.4%–11.9%, I2 = 56%) of patients. Other devices investigated included patch sensors, handheld ECG recorders and PPG-based smartphone apps, which demonstrated feasibility in the post-cryptogenic stroke and post-ESUS setting.
Conclusion:
Wearable devices that are ECG or PPG based are effective for paroxysmal AF detection after cryptogenic stroke and ESUS, but further studies are needed to establish how they compare with Holter monitors and implantable loop recorder. |
| format | Article |
| id | doaj-art-1bb87703bb064c6ebb24f31ff2e4c6d4 |
| institution | Kabale University |
| issn | 0037-5675 2737-5935 |
| language | English |
| publishDate | 2024-07-01 |
| publisher | Wolters Kluwer – Medknow Publications |
| record_format | Article |
| series | Singapore Medical Journal |
| spelling | doaj-art-1bb87703bb064c6ebb24f31ff2e4c6d42025-02-09T10:24:20ZengWolters Kluwer – Medknow PublicationsSingapore Medical Journal0037-56752737-59352024-07-0165737037910.4103/singaporemedj.SMJ-2022-143Use of wearable technology in cardiac monitoring after cryptogenic stroke or embolic stroke of undetermined source: a systematic reviewJamie SY HoElizabeth SY HoLeonard LL YeoWilliam KF KongTony YW LiBenjamin YQ TanMark Y ChanVijay K SharmaKian-Keong PohChing-Hui SiaIntroduction: Prolonged cardiac monitoring after cryptogenic stroke or embolic stroke of undetermined source (ESUS) is necessary to identify atrial fibrillation (AF) that requires anticoagulation. Wearable devices may improve AF detection compared to conventional management. We aimed to review the evidence for the use of wearable devices in post-cryptogenic stroke and post-ESUS monitoring. Methods: We performed a systematic search of PubMed, EMBASE, Scopus and clinicaltrials.gov on 21 July 2022, identifying all studies that investigated the use of wearable devices in patients with cryptogenic stroke or ESUS. The outcomes of AF detection were analysed. Literature reports on electrocardiogram (ECG)-based (external wearable, handheld, patch, mobile cardiac telemetry [MCT], smartwatch) and photoplethysmography (PPG)-based (smartwatch, smartphone) devices were summarised. Results: A total of 27 relevant studies were included (two randomised controlled trials, seven prospective trials, 10 cohort studies, six case series and two case reports). Only four studies compared wearable technology to Holter monitoring or implantable loop recorder, and these studies showed no significant differences on meta-analysis (odds ratio 2.35, 95% confidence interval [CI] 0.74–7.48, I2 = 70%). External wearable devices detected AF in 20.7% (95% CI 14.9–27.2, I2 = 76%) of patients and MCT detected new AF in 9.6% (95% CI 7.4%–11.9%, I2 = 56%) of patients. Other devices investigated included patch sensors, handheld ECG recorders and PPG-based smartphone apps, which demonstrated feasibility in the post-cryptogenic stroke and post-ESUS setting. Conclusion: Wearable devices that are ECG or PPG based are effective for paroxysmal AF detection after cryptogenic stroke and ESUS, but further studies are needed to establish how they compare with Holter monitors and implantable loop recorder.https://journals.lww.com/10.4103/singaporemedj.SMJ-2022-143cardiac monitoringcryptogenic strokeembolic stroke of undetermined sourcewearable devices |
| spellingShingle | Jamie SY Ho Elizabeth SY Ho Leonard LL Yeo William KF Kong Tony YW Li Benjamin YQ Tan Mark Y Chan Vijay K Sharma Kian-Keong Poh Ching-Hui Sia Use of wearable technology in cardiac monitoring after cryptogenic stroke or embolic stroke of undetermined source: a systematic review Singapore Medical Journal cardiac monitoring cryptogenic stroke embolic stroke of undetermined source wearable devices |
| title | Use of wearable technology in cardiac monitoring after cryptogenic stroke or embolic stroke of undetermined source: a systematic review |
| title_full | Use of wearable technology in cardiac monitoring after cryptogenic stroke or embolic stroke of undetermined source: a systematic review |
| title_fullStr | Use of wearable technology in cardiac monitoring after cryptogenic stroke or embolic stroke of undetermined source: a systematic review |
| title_full_unstemmed | Use of wearable technology in cardiac monitoring after cryptogenic stroke or embolic stroke of undetermined source: a systematic review |
| title_short | Use of wearable technology in cardiac monitoring after cryptogenic stroke or embolic stroke of undetermined source: a systematic review |
| title_sort | use of wearable technology in cardiac monitoring after cryptogenic stroke or embolic stroke of undetermined source a systematic review |
| topic | cardiac monitoring cryptogenic stroke embolic stroke of undetermined source wearable devices |
| url | https://journals.lww.com/10.4103/singaporemedj.SMJ-2022-143 |
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