ABSTRACT NUMBER: ESOC2026A1800 CARDIAC MONITORING FOR DETECTION OF ATRIAL FIBRILLATION AFTER TIA: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Background and aims The optimal ECG monitoring method for sensitive detection of atrial fibrillation (AF) after TIAs is uncertain. This systematic review and meta-analysis aim to determine the rate of newly diagnosed AF using various ECG monitoring methods and durations after TIA. Methods A literature search from 1966 through May 31, 2025, was conducted in accordance with PRISMA guidelines using a protocol registered in PROSPERO (CRD420251075716). Prospective observational studies and randomized controlled trials were considered that included TIA patients who underwent >12 hours of cardiac monitoring. Primary outcome was newly detected AF of ≥30 seconds duration, with subgroup analyses by monitoring duration and method. Results 42 studies enrolling 3,981 TIA patients were included. The pooled AF detection rate was 6.5% (95% CI: 4.5–9.3%). Yield of monitoring was higher in in selected cohorts characterized by higher age, cryptogenic stroke etiology, and a more comprehensive diagnostic stroke workup than in unselected cohorts (8.95% vs 4.51%). Pooled AF detection rates rose with monitoring duration: 3.5% (1 day), 6.3% (7 days), 9.6% (30 days), 13.1% (90 days), 19.1% (12 months). Implantable cardiac monitors yielded a significantly higher AF detection rate than non-invasive cardiac monitoring (i.e., serial ECGs, 24-72h Holter, in-hospital telemetry) (20.8% vs. 4.7%). Substantial heterogeneity was observed among studies (I2 = 81.9%). Conclusions This meta-analysis including several studies with prolonged and invasive ECG monitoring found a high detection rate of AF in TIA patients. Randomized studies comparing the impact of different ECG monitoring methods on clinical endpoints are needed in TIA patients. Conflict of interest Alexander W Veltkamp: nothing to disclose. Eleni Korompoki: Speaker Honoraria/Advisory boards/Travel grants: Amgen, AstraZeneca, Bayer, Elpen, Innovis, Pfizer, Sanofi. Lucio D'Anna: nothing to disclose. Manuel C Olma: nothing to disclose. Karl Georg Haeusler: Speaker´s honoraria, consulting fees, lecture honoraria and/or study grants from Abbott, Amarin; Alexion, AstraZeneca, Bayer Healthcare, Biotronik, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb, Daiichi Sankyo, Edwards Lifesciences, Medtronic, Novartis, Pfizer, Portola, Premier Research, Sanofi, SUN Pharma, and W.L. Gore and Associates. Matthias Endres: funding from DFG under Germany´s Excellence Strategy – EXC-2049 – 390688087 , Collaborative Research Center ReTune TRR 295- 424778381, Clinical Research Group KFO 5023 BeCAUSE-Y, project 2 EN343/16-1, Research Group FOR 5930 AbsInVasc, project 6 EN343/18-1, BMBF, DZNE, DZHK, DZPG, and EU; grants from Bayer and Ipsen, and fees paid to the Charité from Amgen, AstraZeneca, Bayer Healthcare, BMS, Daiichi Sankyo, all outside the submitted work. Roland Veltkamp: research support from European Union’s Horizon 2020 research and innovation program under grant agreement No 754517, and from Bayer, BMS-Pfizer, Boehringer Ingelheim, Daiichi Sankyo, Medtronic, Biogen. Honoraria for consultancies and lectures for Astra Zeneca, Bayer, BMS-Pfizer, Javelin, Portola, and he is an investigator of the Imperial BRC.