Left Atrial Imaging Prior to Cardioversion: Leveraging Computed Tomography to Rule Out Thrombus in The Emergency Department (LA CLOTTED)

Launched by OTTAWA HEART INSTITUTE RESEARCH CORPORATION · May 30, 2025

Keywords

ClinConnect Summary

The LA CLOTTED trial is a study designed to find out if using a special heart imaging technique called cardiac computed tomography angiography (CCT) can help patients with atrial fibrillation (AF) or atrial flutter who need to check for blood clots before a procedure called cardioversion. This trial will compare the outcomes of patients who receive CCT in the emergency department to those who receive the usual care. The main goals are to see if CCT can help reduce hospital stays, lower the chances of having to return to the hospital, and improve patients' quality of life.

To be eligible for this trial, participants must be at least 18 years old and have symptomatic AF that isn't caused by other medical conditions. They must also need imaging to check for blood clots before cardioversion according to local guidelines. Those who are experiencing serious heart problems or cannot undergo CCT for specific reasons, such as kidney issues or allergies to contrast dye, will not be included. Participants will either undergo the CCT-facilitated cardioversion or receive standard care while in the emergency department, and they will fill out questionnaires about their quality of life both in the ED and after 30 days.

Gender

ALL

Eligibility criteria

• 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)