It's a privilege and honor for me to have been able to be part of this big effort to get this product over the finish line and to be able to work with so many great minds in electrophysiology as part of this project. I want to take the opportunity to thank all the participants in getting this effort really over the finish line and not just over the finish line but also in time over the finish line and in good time too. Special thanks to the HRS staff who was really engaged and without the help especially of Valentina we would never have been able to meet the deadline. She was constantly reminding us about the deadlines and really cracking the whip on us. I'm exaggerating here. But she was tireless and worked on the weekends and after hours on sending out surveys, correcting the surveys, looking at the statistics of the surveys, doing proofing, correcting, making sure the references were all correct and going over the references again which is quite an amount of effort. I want to thank all the members of the writing committees for spending an incredible amount of work and effort writing their documents to discuss different issues, attending the conference calls, discussing again different issues that were already discussed in the past and then revising all the information that they have already written once and sending in the information again. A lot of tedious work. I want to thank especially my co-chair, Dr. Cronin, who spent a huge amount of effort and time going over the recommendations and addressing each of the individual concerns that many people had and there were many concerns, many concerns that were filed often on a last minute basis and they were all correct, they were all answered in a diplomatic manner so that at the end we actually had an agreement in all of the recommendations and all of the consensus recommendations that were issued. The document is a huge document and it's really difficult to consume this as a single entity. However, it's written in bite-size sections that allow for easier digestion and I hope that this format together with the great content that it has allows for this document to be applicable and useful on a day-to-day basis. It has a key section which is section 9 which is a how-to section with many practical advices that you should read. There are many sections with specific topics that are relevant to every type of ventricular arrhythmia ablation. One of the possibilities to read this document is when you, for example, I thought you could look at your cases that are coming up in the week or so and then look up specific parts of the document that help you navigate through the document and help you with the cases. For example, I looked in a few weeks ago, we had a patient, 58-year-old woman, frequent PVC, 35% PVC burden, failed prior ablations in the outflow for outflow tract PVCs. They were targeted from the sinus of Valsalva and RVOT, the ejection fraction was 30%. You can start with section 3, the diagnostic evaluation, look at the risk stratification for frequent PVCs. You will see that MRIs are 2A and PVCs and program ventricular stimulation 2A recommendation as you can see here in these people to adequately risk stratify them. You can then look at section 4, look at the PVCs in associated with LV dysfunction and see that this is a class 1 recommendation for ablation. You can then look at sections 8.6 because it was mentioned that prior ablation was carried out in the sinus of Valsalva. Need to be aware that you need a coronary angiogram prior to the ablation if the ablation is indeed carried out in the coronary venous system and echo is sufficient to identify the coronary arteries in the sinus of Valsalva as shown here with these recommendations. You can then look in the section 9 which is really the heart of the document with a how-to section where you can look at the specifics of ablation, deeper lesions may be required. You can consider half use of half normal saline and then you can look at outflow tract arrhythmias. Deep septal sites are specifically discussed approach in the diagnosis state-of-the-art approach with the appropriate literature that can help you to know that what you're doing is hopefully the correct thing. In the case example, we did an MRI that showed a large intraceptive scar. PVC origin was epicardial. The site of origin too close to the LAD from the great cardiac vein and from the RVOT. The PVCs could not be completely eliminated and medical therapy was favored for PVC suppression. The patient had four rapidly inducible monomorphic VTs during program stimulation that was carried out for risk stratification and the patient underwent ICD implantation prior to discharge. I wish that this document will be received well by the EP community and that it will be read by all personnel involved in VT ablation procedures, not just electrophysiologists but also other people that are involved in ventricular arrhythmia ablation procedures. And that hopefully this document will enhance the safety of the procedures that we do and will hopefully also contribute to improved patient care. This completes my presentation.

electrophysiology

HRS staff

recommendations

practical advice

improved patient care