Related Experiment Video
Updated: Apr 28, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Safety and Feasibility of a CT-Based Pathway for Left Atrial Appendage Assessment Prior to Inpatient Cardioversion: A
Ariel Furer1,2, Maxim Perelman3,4, Yafim Brodov1,4,5
1Department of Cardiology, Chaim Sheba Medical Center, Ramat-Gan, Israel.
Insights
Cardiac CT imaging offers a feasible alternative to transesophageal echocardiography for left atrial appendage thrombus assessment before cardioversion. This study found no significant increase in short-term thromboembolic events or safety concerns with the CT pathway.
Area of Science:
- Cardiology
- Medical Imaging
- Atrial Fibrillation Management
Background:
- Transesophageal echocardiography (TEE) for left atrial appendage (LAA) thrombus exclusion before cardioversion has logistical challenges.
- Limited availability, patient intolerance, and procedural delays hinder TEE use.
- A cardiac CT-based pathway is explored as an alternative for hospitalized atrial fibrillation (AF) patients.
Purpose of the Study:
- To evaluate the feasibility and short-term safety of a cardiac CT-based imaging pathway.
- To compare outcomes of CT-guided versus TEE-guided cardioversion in AF patients.
- To assess the role of CT as an alternative to TEE for LAA thrombus assessment.
Main Methods:
- Retrospective single-center study of 408 consecutive AF inpatients undergoing cardioversion.
- Patients were divided into CT-guided (n=74) and TEE-guided (n=206) groups.
- Primary endpoint: stroke/TIA or systemic embolism within 48 hours post-cardioversion. Secondary endpoints included 30-day thromboembolic events, AKI, and mortality.
Main Results:
- No periprocedural strokes or TIAs occurred within 48 hours in either group (0% CT vs. 0% TEE).
- 30-day TIA rate was 1.4% in the CT group versus 0% in the TEE group.
- Acute kidney injury rates were 8.1% (CT) and 3.9% (TEE); no significant difference in mortality observed.
Conclusions:
- A CT-based imaging pathway for LAA assessment before cardioversion is feasible and safe in the short term.
- No periprocedural thromboembolic events were observed with the CT approach.
- Prospective randomized trials are necessary to establish the definitive clinical role of CT compared to TEE.
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.
Related Concept Videos
01:24Cardiac Catheterization III: Left Heart Catheterization
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:28Imaging Studies for Cardiovascular System V: CT
01:21Cardiac Catheterization II: Right Heart Catheterization