Department of Medicine, Alexandra Hospital, Singapore.
Department of Computer Science and Technology, University of Cambridge, Cambridge, UK.
Singapore Med J. 2024 Jul 1;65(7):370-379. doi: 10.4103/singaporemedj.SMJ-2022-143. Epub 2024 Mar 6.
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.
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.
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, I 2 = 70%). External wearable devices detected AF in 20.7% (95% CI 14.9-27.2, I 2 = 76%) of patients and MCT detected new AF in 9.6% (95% CI 7.4%-11.9%, I 2 = 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.
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.
为了确定需要抗凝治疗的心房颤动（AF），对于隐源性卒中和来源不明的栓塞性卒中（ESUS）患者，需要进行延长的心脏监测。可穿戴设备可能比常规治疗更有助于 AF 的检测。我们旨在回顾在隐源性卒中和 ESUS 后监测中使用可穿戴设备的证据。
我们于 2022 年 7 月 21 日在 PubMed、EMBASE、Scopus 和 clinicaltrials.gov 上进行了系统搜索，以确定所有研究隐源性卒中和 ESUS 患者中使用可穿戴设备的研究。分析了 AF 检测结果。总结了基于心电图（ECG）（外部可穿戴、手持、贴片、移动心脏遥测[MCT]、智能手表）和光电容积脉搏波（PPG）（智能手表、智能手机）的设备的文献报告。
共纳入 27 项相关研究（两项随机对照试验、七项前瞻性试验、十项队列研究、六项病例系列研究和两项病例报告）。仅有四项研究将可穿戴技术与动态心电图监测或植入式环路记录器进行了比较，且这些研究在荟萃分析中无显著差异（比值比 2.35，95%置信区间[CI]0.74-7.48，I 2 =70%）。外部可穿戴设备在 20.7%（95%CI 14.9-27.2，I 2 =76%）的患者中检测到 AF，MCT 在 9.6%（95%CI 7.4%-11.9%，I 2 =56%）的患者中检测到新发 AF。研究还涉及贴片传感器、手持 ECG 记录器和基于 PPG 的智能手机应用程序，这些设备在隐源性卒中和 ESUS 后均具有可行性。
基于 ECG 或 PPG 的可穿戴设备可有效检测隐源性卒中和 ESUS 后的阵发性 AF，但仍需要进一步研究来确定其与动态心电图监测和植入式环路记录器的比较情况。
