Dispositivos digitais e tecnologias emergentes no diagnóstico precoce da fibrilação atrial e sua influência na prevenção do acidente vascular cerebral: revisão sistemática

Abstract

Digital devices and emerging technologies have been used for screening and early diagnosis of atrial fibrillation, a frequently asymptomatic arrhythmia associated with an increased risk of stroke. The objective was to assess whether these digital devices and emerging technologies enhance atrial fibrillation detection and contribute to stroke prevention compared with the 12-lead electrocardiogram (ECG) gold-standard method. This systematic review followed PRISMA guidelines and included searches in the BVS, Cochrane Library, LILACS, PubMed, Scopus, and Web of Science databases. Risk of bias was assessed using the Cochrane RoB 2.0 tool. Seven randomized clinical trials were included, totaling 56,287 participants. The evaluated devices were long-term adhesive monitors, implantable loop recorders, single-lead portable electrocardiograms, continuous digital Holter monitors, and smartphone applications. Atrial fibrillation detection was higher in the intervention groups (5.3% to 31.8%) compared with controls (0.5% to 12.8%), resulting in an increase in anticoagulation of 2.0 to 3.7 per 100 person-years. Regarding cerebrovascular outcomes, the STROKESTOP study demonstrated a 4% reduction, and the LOOP study observed a clinically relevant 20% reduction. It is concluded that digital devices increase atrial fibrillation detection and anticoagulation; however, evidence for stroke reduction remains limited. The use of these technologies should consider cost-effectiveness, adherence, target population, and integration into health systems.