Early Evaluation of Left Atrial Appendage With Cardiac Computed Tomography to Reduce Health Care Utilization.

BACKGROUND

Transesophageal echocardiography (TEE) is routinely used to exclude left atrial appendage thrombus before direct current cardioversion (DCCV) in atrial fibrillation/atrial flutter but is invasive and limited by procedural availability. Cardiac computed tomography (CCT) offers a noninvasive alternative.

PROJECT RATIONALE: Limited access to TEE may delay DCCV and prolong hospital length of stay (LOS). We hypothesized that an early CCT-guided pathway would reduce time to cardioversion and LOS.

PROJECT SUMMARY: Adult patients hospitalized with atrial fibrillation/atrial flutter underwent CCT-guided evaluation. Twenty-two patients were included across 2 plan-do-study-act cycles. Mean time-to-DCCV was 0.75 and 1.0 days, with LOS of 3.9 and 4.6 days, respectively. No acute kidney injury or anesthesia-related complications occurred. Compared with a historical TEE-guided cohort (n = 278), CCT was associated with shorter time-to-DCCV (3.8 days) and LOS (6.3 days).

TAKE-HOME MESSAGE: Early, standardized use of CCT is feasible, safe, and reduces treatment delays.