2024 ACC Expert Consensus Decision Pathway on Practical Approaches for Arrhythmia Monitoring After Stroke: A Report of the American College of Cardiology Solution Set Oversight Committee

Abstract

Section snippets

Solution Set Oversight Committee

Nicole M. Bhave, MD, FACC, ChairNiti R. Aggarwal, MD, FACCKatie Bates, ARNP, DNPJohn P. Erwin III, MD, FACCMartha Gulati, MD, MS, FACCDharam J. Kumbhani, MD, SM, FACCGurusher S. Panjrath, MBBS, FACCBarbara Wiggins, PharmD, FACCMegan Coylewright, MD, MPH, FACC, Ex Officio

Table of Contents

• 1.Introduction 2
• 2.Assumptions and Definitions 3
  • 2.1.General Clinical Assumptions 3
  • 2.2.Definitions 3
• 3.Pathway Summary Graphic 4
  • Figure 1. Pathway Summary Graphic 4
• 4.Description, Rationale, and Implication of Pathway 4
  • 4.1.Adults With Stroke of Presumed Cardiac Origin Who Require Anticoagulation 4
    • 4.1.1.Role for Monitoring 4
      • Figure 2. Flowchart of Poststroke Monitoring and Treatment Strategy 5
  • 4.2.Adults With Ischemic Stroke From Presumed Small- or Large-Vessel Disease 5
    • 4.2.1.Role for Monitoring 7
  • 4.3.Adults With Ischemic Stroke and Unclear Source 8
    • 4.3.1.Role

Assumptions and Definitions

To facilitate interpretation of the recommendations provided in this ECDP, specific assumptions were made by the writing committee, as specified.

Pathway Summary Graphic

Arrhythmia monitoring after a stroke requires three important steps (Figure 1). The first is a multidisciplinary evaluation to identify any potential mechanisms for the stroke. Ultimately, the stroke may be determined to be cryptogenic. The second step is risk assessment to determine the likelihood that a cardiac arrhythmia played a role in the stroke or may play a role in future stroke or nonstroke morbidity. The final step is choosing the optimal monitoring strategy for the patient that

Adults With Stroke of Presumed Cardiac Origin Who Require Anticoagulation

Many patients with an ischemic stroke of presumed cardiac origin require anticoagulation to reduce the risk of future events. Conditions that warrant consideration for long-term anticoagulation include AF, left atrial or left ventricular thrombus, postablation electrical isolation of the left atrial appendage, rheumatic mitral stenosis with an embolic event, mechanical heart valves, cardiac amyloidosis, left ventricular noncompaction, severely reduced ejection fraction (particularly when

President and Staff

Cathleen Biga, MSN, FACC, PresidentCathleen C. Gates, Chief Executive OfficerRichard J. Kovacs, MD, MACC, Chief Medical OfficerBrendan Mullen, Senior Executive Vice PresidentJoseph M. Allen, MA, Team Lead, Science and QualityAmy Dearborn, Team Lead, Decision ScienceAshleigh M. Covington, MA, Team Lead, Decision Science DeliveryAlan Shinkar, MPH, Associate, Decision Science DeliveryGrace D. Ronan, Senior Production and Operations Manager, Scientific Publications and Guidelines