The goal of this randomized clinical trial is to learn whether patients with symptomatic atrial fibrillation or atrial flutter (AF) who require heart imaging to rule out a blood clot before cardioversion would benefit from cardiac computed tomography angiography (CCT) in the emergency department (ED) compared to current standard of care management.
This will be a multicenter trial evaluating whether CCT-facilitated cardioversion in the ED reduces hospital admission, reduces repeat presentations to hospital and improves patient quality of life compared to the current standard of care.
Participants will undergo CCT-facilitated cardioversion or be treated according to current standard of care while in the ED and complete quality of life questionnaires in the ED and follow-up at 30 days.
Age ≥18 years old; and
Primary symptomatic AF without a reversible underlying cause (e.g. sepsis, pneumonia, pulmonary embolism, hyperthyroidism)
LA imaging required before cardioversion according to local clinical practice guidelines
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
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)