Using a quick CT scan to check for left atrial clots before cardioversion in the Emergency Department

Is this trial a fit for you?

A plain-English reading of the study's rules. Only the study team can confirm whether you qualify.

What this trial studies

This randomized multicenter trial compares cardiac computed tomography angiography (CCT)–facilitated cardioversion in the emergency department to current standard care for patients with symptomatic atrial fibrillation or flutter who need left atrial imaging before cardioversion. Patients randomized to the CCT arm will have a CT to rule out thrombus and, if no clot is seen, may undergo immediate chemical or electrical cardioversion in the ED; the control arm follows local standard practice (which may include TEE, admission, or outpatient anticoagulation). The study will measure hospital admission rates, repeat ED presentations, and patient quality of life with follow-up at 30 days. CCT is more widely available than TEE and has shown high sensitivity and specificity for detecting left atrial thrombus in diagnostic studies, so this trial tests the pathway impact of using CCT in real-world ED care.

Why it matters

Who can join: the full rules

Inclusion Criteria:

1. Age ≥18 years old; and
2. Primary symptomatic AF without a reversible underlying cause (e.g. sepsis, pneumonia, pulmonary embolism, hyperthyroidism)
3. LA imaging required before cardioversion according to local clinical practice guidelines

Exclusion Criteria:

1. Patients with an indication for emergency cardioversion (e.g. hemodynamic instability (systolic blood pressure\<90mmHg or signs of shock), cardiac ischemia (ongoing severe chest pain or marked ST depression on ECG \>2mm), or pulmonary edema (significant dyspnea, crackles, or hypoxia)); or
2. Contraindication to CCT (renal insufficiency (eGFR\< 45ml/min/1.73m2), allergy to intravenous contrast agents, pregnancy (contraindications to radiation exposure), or inability to perform 20-second breath-hold)

Where it's running

• Penn State Health Milton S. Hershey Medical Center
  Hershey, Pennsylvania, United States Recruiting
• The Ottawa Hospital Civic Campus
  Ottawa, Ontario, Canada Recruiting
• Sunnybrook Health Sciences Centre
  Toronto, Ontario, Canada Recruiting

Study contacts

• Principal investigator: Benjamin Chow, MD PhD FRCPC FACC FESC FA — Ottawa Heart Institute Research Corporation
• Study coordinator: Farrah Ahmed
• Email: fahmed@ottawaheart.ca
• Phone: 613-696-7000

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How to take part

1. Review the eligibility criteria above with your treating physician.
2. Check the official listing on ClinicalTrials.gov for the latest contact details and recruitment status.
3. Contact the study coordinator or principal investigator to ask for pre-screening. Pre-screening is free and never obligates you to enroll.