Ladies and gentlemen, dear colleagues, my name is Helmut Pürer-Wilner and I'm based in Linz, Austria in Central Europe. I'm head of the Department of Electrophysiology at the Ordensklinikum Linz-Elisabethinen. My topic is pre-procedural VT substrate determination and I want to show you two cases of my patient series. For this purpose, I use both echocardiography but also CT and MRI imaging. And what I do is that I use my CTs and MRI in a way that I upload files to a central music network. It's called Music Network that is based in Bordeaux, at the University of Bordeaux, where we have a collaboration. And I then download the images two days later to get 3D images of a scar. So that's the way we do it in short and in brief. So let me go to the first case. This is a patient with a large myocardial infarction, anterior infarction. And on the right hand side, you see these scars. You can appreciate in colors from yellow to red, different wall thickness states of this substrate. And you can see in blue and light blue a late iodine expression of the scar with a dense scar and scar. And in the middle, you see a merging of the 3D electron atomic mapping on the left side and this CT that is pre-interventionally performed into a shell here where we then ablated at the site where we had good correlation with these images and nice electrograms. And this was very useful. In the second patient, you can see a patient with arrhythmogenic cardiomyopathy and you can appreciate in yellow intramural fatty infiltrations. And that is the substrate in this patient where we ablated. You can see here the 3D electron atomic mapping. But we were close to the coronaries. So we used the MediGuide system. You can see it in the next image to see the coronary arteries and to have them in pre-recorded cine images along with the actual site of our ablation catheter so that we don't touch the coronaries in this patient. So, colleagues, to come to my takeaway messages, pre-interventional imaging can be useful for locating scars, for looking at wall thickness and transmorality, for looking at the core and border zone transition, for appreciating intramural fat and calcification, especially in arrhythmogenic cardiomyopathy, to rule in or rule out left ventricular involvement, and for the integration and segmentation of the scar into the 3D electroanatomic mapping system to guide mapping and to reduce procedure and fluoroscopy time. It can also be used for anatomic location of the pericardial access and also to estimate the site of the coronary arteries and the phrenic nerve in order to prevent complications. Thank you.

pre-interventional imaging

substrate for ventricular tachycardia

echocardiography

CT

MRI