Diagnostic Yield of Extended Cardiac Monitoring in Transient Unexplained Vertigo: A Systematic Review and Meta-Analysis

When recurrent transient vertigo cannot explain by the problems with peripheral vestibular system, then doctors encounter a diagnostic challenge. In certain patients, these episodes may indicate temporary reduced blood flow to the brain and the reason is previously un-noticed paroxysmal atrial fibrillation. However, standard short-term heart monitoring often misses these occasional irregular heartbeats, creating a significant gap in stroke prevention strategies. Methods: Following the PRISMA 2020 guidelines, we have compiled this systematic review and meta-analysis [8, 9]. And manually searched the records of PubMed, Embase, and the Cochrane Library for similar studies that were published after 2010 and compared extended cardiac monitoring (ECM, >48 hours) with standard monitoring (≤48 hours) in adults having unexplained recurrent transient vertigo [10, 11]. Two independent reviewer screened the studies, found eligibility, and remove the risk of biasness using the RoB 2.0 and ROBINS-I tools [12, 13]. The review aims to find the primary endpoint, known as the diagnostic yield of atrial fibrillation, whereas the secondary endpoint is represented by the long-term occurrence of stroke or transient ischemic attack (TIA). Results: A dozen studies, including 4,589 participants, were found eligible for both qualitative and quantitative synthesis [14, 15]. The pooled analysis showed that extended cardiac monitoring markedly improved the detection of atrial fibrillation compared with short-term monitoring (pooled odds ratio = 3.51; 95% confidence interval, 2.11–5.85; p < 0.001) [16, 17]. Considerable statistical heterogeneity was observed among the included studies (I² = 78.4%) [18, 19]. From the qualitative summary of four studies, it appeared that higher AF detection followed by initiation of oral anticoagulation therapy was linked with an estimated absolute risk reduction of 1.8% for stroke or transient ischemic attack over a two-year period [20, 21]. However, including several non-randomized studies contributes a moderate to serious risk of bias, especially in the evaluation of long-term outcomes [22, 23]. Conclusion: Extended cardiac monitoring occur more than 48 hours and shown a clear advantage over standard short-term monitoring in detecting new-onset atrial fibrillation among patients with unexplained recurrent transient vertigo [1, 24]. Is present strong diagnostic yield and the observed link between early AF detection, timely anticoagulation, and lower stroke risk, there compelling is needed to revise existing cardiac screening guidelines for this high-risk group. So, monitoring cardiac activity for longer-duration in routine practice could significantly enhance both diagnosis and prevention strategies [25, 26].