19 Dec 2024 • The following are key points to remember from a 2024 American College of Cardiology (ACC) expert consensus decision pathway (ECDP) on practical approaches for arrhythmia monitoring after stroke:

• Arrhythmia monitoring after a stroke requires three important steps. First, a multidisciplinary evaluation should be undertaken to identify potential mechanism for stroke. Second, risk assessment is performed to determine the likelihood that a cardiac arrhythmia played a role in the stroke (or future stroke). Third, an optimal monitoring strategy should be selected to be accurate, practical, and establish follow-up.
• For patients with a high-risk cardioembolic source (including those with AF detected before the stroke), long-term anticoagulation is recommended. Cardiac monitoring is only needed if a patient no longer desires or requires anticoagulation therapy or if there is concern for another arrhythmia (e.g., bradycardia, pauses).
• For patients with large- or small-vessel disease, long-term antiplatelet therapy is recommended. Cardiac monitoring may be considered, preferably for ≥14 days. An implanted loop recorder can be considered in high-risk patients.
• For patients with an unclear source of their stroke (i.e., cryptogenic), long-term antiplatelet therapy is recommended.
• For patients in whom arrhythmia monitoring detects >5 minutes of AF, anticoagulation is likely recommended. For those with no AF, continuing antiplatelet therapy is recommended.
• In patients with stroke from a presumed cardioembolic origin, there is a limited role for rhythm monitoring given that anticoagulation is presumed necessary. Monitoring should only be considered if there is discussion around stopping anticoagulation or other treatments based on rhythm detection.

Source: ACC | Read Full Story