{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T17:05:45Z","timestamp":1784653545066,"version":"3.55.0"},"reference-count":33,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T00:00:00Z","timestamp":1784419200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["NeuroSci"],"abstract":"<jats:p>Background: Atrial fibrillation (AF) is a common but frequently undiagnosed cause of ischemic stroke, particularly among patients with cryptogenic stroke and embolic stroke of undetermined source (ESUS). Implantable cardiac monitors (ICMs) enable prolonged continuous rhythm monitoring and may improve AF detection following ischemic stroke or transient ischemic attack (TIA). This systematic review and meta-analysis aimed to evaluate the diagnostic yield, clinical impact, and safety of prolonged ICM monitoring in patients with ischemic stroke or TIA. Methods: This systematic review and meta-analysis was conducted in accordance with the PRISMA 2020 guidelines and registered with PROSPERO (CRD42024573913). PubMed, Google Scholar, and the Cochrane Library were systematically searched. Randomized controlled trials and observational studies evaluating the use of ICMs after ischemic stroke or TIA were included. Randomized evidence was synthesized narratively, whereas single-arm random-effects meta-analyses of observational studies were performed to estimate pooled proportions for AF detection, oral anticoagulation initiation, recurrent ischemic stroke or TIA, and device-related adverse events. Results: Twelve completed studies involving 4563 participants met the inclusion criteria, including two randomized controlled trials and ten observational studies. One additional ongoing randomized controlled trial (Find-AF 2) involving a planned enrollment of 5200 participants was identified and is described narratively. Across the observational studies, the pooled AF detection rate during prolonged ICM monitoring was 25.9% (95% CI, 18.9\u201333.5%), although substantial heterogeneity was observed (I2 = 95%). Oral anticoagulation was initiated in 94.2% (95% CI, 79.4\u2013100.0%) of patients diagnosed with AF. Device-related complications were uncommon, with a pooled incidence of 3.7% (95% CI, 2.0\u20136.0%; I2 = 0%), while the pooled rate of recurrent ischemic stroke or TIA during follow-up was 6.2% (95% CI, 3.9\u20139.2%). Narrative synthesis of the randomized evidence demonstrated that ICMs significantly increased AF detection compared with conventional monitoring but did not demonstrate a significant reduction in recurrent stroke during the available follow-up period. Conclusions: Prolonged implantable cardiac monitoring identifies AF in approximately one-quarter of patients following ischemic stroke or TIA and frequently leads to the initiation of oral anticoagulation, with a favorable safety profile. Although ICMs substantially improve AF detection, current evidence remains insufficient to confirm that increased detection translates into a reduction in recurrent stroke. Large, adequately powered randomized controlled trials are needed to determine the long-term clinical benefits of ICM-guided management and to define the optimal monitoring strategy for patients following ischemic stroke.<\/jats:p>","DOI":"10.3390\/neurosci7040083","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T12:00:17Z","timestamp":1784548817000},"page":"83","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Implantable Cardiac Monitoring for Atrial Fibrillation Detection in Patients with Stroke: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"7","author":[{"given":"Nibras M.","family":"Alkhamis","sequence":"first","affiliation":[{"name":"College of Medicine, King Faisal University, Al Ahsa 31982, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hussain A.","family":"Almohammed","sequence":"additional","affiliation":[{"name":"College of Medicine, King Faisal University, Al Ahsa 31982, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanveer N.","family":"Khan","sequence":"additional","affiliation":[{"name":"General Medicine Program, Batterjee Medical College, Jeddah 21442, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jory H.","family":"Alzahrani","sequence":"additional","affiliation":[{"name":"College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah 21423, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lama A.","family":"Alsalboud","sequence":"additional","affiliation":[{"name":"College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randah T.","family":"Alzahrani","sequence":"additional","affiliation":[{"name":"College of Medicine, King Abdulaziz University, Jeddah 23452, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamad A.","family":"Alseni","sequence":"additional","affiliation":[{"name":"College of Medicine, King Abdulaziz University, Jeddah 23452, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amara M.","family":"Mufti","sequence":"additional","affiliation":[{"name":"College of Medicine, Fakeeh College for Medical Sciences, Jeddah 23323, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5857-3529","authenticated-orcid":false,"given":"Lujeen H.","family":"Alghourab","sequence":"additional","affiliation":[{"name":"Dammam Medical Complex, Eastern Health Cluster, Dammam 32253, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thekra F.","family":"Abuhaimed","sequence":"additional","affiliation":[{"name":"College of Medicine, King Abdulaziz University, Jeddah 23452, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manar M.","family":"Alshabaan","sequence":"additional","affiliation":[{"name":"College of Medicine & Surgery, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maha E.","family":"Alsubaie","sequence":"additional","affiliation":[{"name":"College of Medicine, King Faisal University, Al Ahsa 31982, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manar A.","family":"Jamlalail","sequence":"additional","affiliation":[{"name":"College of Medicine, King Abdulaziz University, Jeddah 23452, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7066-9063","authenticated-orcid":false,"given":"Saud A.","family":"Alnaaim","sequence":"additional","affiliation":[{"name":"Clinical Neurosciences Department, College of Medicine, King Faisal University, Al Ahsa 31982, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1016\/S0140-6736(17)32152-9","article-title":"Global, regional, and national age-sex specific mortality for 264 causes of death, 1980\u20132016: A systematic analysis for the Global Burden of Disease Study 2016","volume":"390","author":"Naghavi","year":"2017","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e139","DOI":"10.1161\/CIR.0000000000000757","article-title":"Heart Disease and Stroke Statistics\u20142020 Update: A Report from the American Heart 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