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September 19, 2026JACC Case ReportsOpen Access

Early CCT linked to ~3 days faster cardioversion and reduced LOS versus historical TEE.

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Why the study?

Limited access to transesophageal echocardiography may delay direct current cardioversion and prolong hospital length of stay in patients with atrial fibrillation or atrial flutter.

Does an early CCT-guided pathway reduce time to cardioversion and hospital length of stay compared to a historical TEE-guided cohort in adult patients hospitalized with atrial fibrillation/atrial flutter?

Comparison

Early cardiac computed tomography-guided evaluation vs historical transesophageal echocardiography-guided evaluation

Design

Cohort study

Follow-up

In-hospital

Key result

An early cardiac computed tomography-guided pathway reduced mean time to cardioversion (0.75-1.0 days vs 3.8 days) and length of stay (3.9-4.6 days vs 6.3 days) compared to historical TEE.

Authors

LZLillian ZhengDMDivyanshu MohananeyVRVictor Redmon

Discussion

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Overview

May shorten time to cardioversion and length of stay; leaves open whether CCT safely replaces TEE pending prospective trials.

Key Points

  • To determine whether an early cardiac computed tomography pathway can safely expedite cardioversion and reduce hospital length of stay compared to conventional transesophageal echocardiography.
  • Implemented a standardized cardiac computed tomography (CCT) imaging protocol across two plan-do-study-act cycles in 22 hospitalized adult patients with atrial fibrillation or flutter.
  • Evaluated procedural safety and clinical timelines in comparison to a historical cohort of 278 patients evaluated with transesophageal echocardiography (TEE).
  • Mean time-to-cardioversion was 0.75 days in cycle 1 and 1.0 days in cycle 2 with CCT, compared with 3.8 days in the historical TEE cohort.
  • Mean hospital length of stay was 3.9 days and 4.6 days across the two CCT cycles, compared with 6.3 days for TEE-guided care.
  • Zero cases of acute kidney injury or anesthesia-related adverse events occurred in the CCT cohort.

Study Design

Type

Cohort (n=300)

Structured PICO

Does an early CCT-guided pathway reduce time to cardioversion and hospital length of stay compared to a historical TEE-guided cohort in adult patients hospitalized with atrial fibrillation/atrial flutter?

P
Population
300 adult patients hospitalized with atrial fibrillation or atrial flutter undergoing evaluation before direct current cardioversion.
E
Exposure
Early cardiac computed tomography (CCT)-guided evaluation before direct current cardioversion
C
Comparator
Historical transesophageal echocardiography (TEE)-guided evaluation
O
Outcome
Time to direct current cardioversion (time-to-DCCV) and hospital length of stay (LOS)

Early CCT-guided evaluation before cardioversion in hospitalized patients with atrial fibrillation or flutter is feasible and reduces time to procedure and length of stay compared to traditional TEE.

Cite This Study

Zheng et al. (2026) conducted a cohort in Atrial fibrillation/atrial flutter (n=300). Cardiac computed tomography (CCT) vs. Transesophageal echocardiography (TEE) was evaluated on Time to cardioversion and hospital length of stay. An early cardiac computed tomography-guided pathway reduced mean time to cardioversion (0.75-1.0 days vs 3.8 days) and length of stay (3.9-4.6 days vs 6.3 days) compared to historical TEE.

synapsesocial.com/papers/6aae47640c69660b71ecc653https://doi.org/10.1016/j.jaccas.2026.109523
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