Left Atrial Imaging Prior to Cardioversion: Leveraging Computed Tomography to Rule Out Thrombus

Left Atrial Imaging Prior to Cardioversion: Leveraging Computed Tomography to Rule Out Thrombus

Evaluating contrast enhanced ECG-gated cardiac CT (CCT) as an alternative to transesophageal echocardiography (TEE) to expedite cardioversion of atrial fibrillation (AF), improve patient care and reduce hospital admissions for AF and atrial flutter.

Inclusion Criteria:

1. Admitted patients who require LA imaging prior to cardioversion
2. Age ≥18 years old
3. Able and willing to comply with the study procedures

Exclusion Criteria:

1. Indication for acute cardioversion (e.g. hemodynamic instability, acute coronary syndrome (ACS), or pulmonary edema)

2. Unwillingness or inability to provide informed consent

3. Contraindication to Cardiac CT

   • Severe renal insufficiency(GFR< 45ml/min)
   • Allergy to intravenous contrast agents
   • Contraindications to radiation exposure (for example, pregnancy)
   • Inability to perform 20-second breath-hold

4. Contraindication to TEE

   • Unrepaired tracheoesophageal fistula
   • Esophageal obstruction or stricture
   • Perforated hollow viscus
   • Poor airway control
   • Severe respiratory depression
   • Uncooperative, unsedated patient