Key result
CT-based LAA assessment before cardioversion matches TEE with zero early strokes or systemic embolisms.
Why the study?
TEE for LAA thrombus exclusion prior to cardioversion faces logistical barriers, prompting evaluation of the feasibility and short-term safety of a cardiac CT-based alternative pathway in hospitalized AF patients.
Does a cardiac CT-based pathway for LAA assessment prior to cardioversion prevent periprocedural thromboembolic events as safely as TEE in hospitalized patients with atrial fibrillation?
Cohort (n=408)
No
Does a cardiac CT-based pathway for LAA assessment prior to cardioversion prevent periprocedural thromboembolic events as safely as TEE in hospitalized patients with atrial fibrillation?
A CT-based imaging pathway for LAA assessment prior to cardioversion is feasible and associated with no periprocedural thromboembolic events, offering a potential alternative to TEE.
Potential TEE alternative for pre-cardioversion LAA assessment in AF but should not yet alter practice; leaves open randomized validation.
BACKGROUND: Transesophageal echocardiography (TEE) for left atrial appendage (LAA) thrombus exclusion before cardioversion faces logistical barriers including limited availability, patient intolerance, and procedural delays. We evaluated the feasibility and short-term safety of a cardiac CT-based alternative pathway in hospitalized patients with atrial fibrillation (AF). METHODS: This retrospective single-center study included 408 consecutive AF inpatients planned for cardioversion. The primary endpoint was the composite of stroke/TIA or systemic embolism within 48 h post-cardioversion. Secondary endpoints included 30-day thromboembolic events, acute kidney injury, and all-cause mortality at 30 days and 1 year. Imaging modality selection was based on availability, clinical factors, and contraindications. RESULTS: Among 74 patients undergoing CT-guided cardioversion and 206 undergoing TEE-guided cardioversion, no strokes or TIAs occurred within 48 h in either group (0/74 CT vs. 0/206 TEE, p = 1.0). By 30 days, one TIA occurred in the CT group (1.4%) and none in the TEE group (0%), representing an absolute risk difference of +1.4% (95% CI: -0.8% to +7.3%; p = 0.26). Acute kidney injury occurred in 8.1% of CT patients compared with 3.9% in the TEE group (absolute risk difference +4.2%, 95% CI: -1.4% to +12.9%; OR 2.18, 95% CI: 0.60-7.45; p = 0.21). No mortality was observed at 30 days or 1 year. CONCLUSIONS: In this single-center feasibility analysis, a CT-based imaging pathway for LAA assessment prior to cardioversion was associated with no periprocedural thromboembolic events and acceptable short-term safety. Prospective randomized trials are needed to define the clinical role of CT as an alternative to TEE.
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Furer et al. (2026) conducted a cohort in Atrial fibrillation (n=408). Cardiac CT-based pathway for LAA assessment vs. Transesophageal echocardiography (TEE) was evaluated on Composite of stroke/TIA or systemic embolism within 48 h post-cardioversion (p=1.0). A CT-based imaging pathway for left atrial appendage assessment prior to cardioversion resulted in no strokes or TIAs within 48 hours, identical to TEE-guided cardioversion (0% vs 0%, p=1.0).
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