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.