24...J.e.A.u.Q _.O.t

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EnSitescar breakthrough1 54 RFCA ATCARTO mapping focal AT focus CARTO mapping 2 RFCA EnSite mapping Scar2 Scar breakthrough Scar mapping Scar Exit ATPHis 1 mapping 12 His

1 EnSitescar breakthrough1 54 RFCA ATCARTO mapping focal AT focus CARTO mapping 2 RFCA EnSite mapping Scar2 Scar breakthrough Scar mapping Scar Exit ATPHis 1 mapping 12 His delayed potential AT ATP ATP delayed potential 59 5 narrow QRS tachycardiahr180bpm EPS jump ups1 S ms PSVTHR195bpm, CL307ms21AV ATP sequencehis focal AT entrainment PPI

2 Exit 1 56 AT 8 6 AT 2 AT AT CARTO voltage map AT 500ms activation map post pacing intervalppi PPI activation map PPI 90ms fractionated potential 2ATP His ATP His 246 narrow QRS tachycardia HR bpmATP 3mg ATP sensitive AT

3 WPW 1 72 long RP narrow QRS regular tachycardia VARV pace long RP His ATP2mg His AT narrow QRS regular tachycardiarv V scan AVRT AVRT AT His QS His AVRT AT regular narrow QRS tachycardia100bpm P CARTOactivation 11 slow conductionblock line Entrainment mapping 10 Post pacing interval150ms Entrainment mapping

4 His 1 27 Long RP tachycardia CARTO mapping His His AH His mapping mapping activation mapping fractionated potential mappingfragmented potential ATPHis / jump up V scan His ATP5mg CARTOHis 20W 10s

5 sbp 80mmHg incessant typehr 200bpm P activation mapping SVC HRAHis CS RSPV activation mapping RSPV 4 5 RSPV isolation RSPV 1 ATP V AAV 1mgATP activation mapping His focal patternhis ATP mapping His His ATP

6 ATP ISP CL390ms ATP ATP P 1cm ATP Slow pathwayablation echo AVNRT SP ablationsp ablation HRA CS ostium long RP tachycardiacl430ms HRA CS ostium CARTO activation mapping CS ostium focal pattern CARTO CS ostium His CS ostiumhrahiscs ostium fraction SP ablation

7 ATP /narrow QRS long R P ATP20mg HRA RVA 4 CSHis HBE 10 isoproterenolisphra msSVT1 CL 250msAH 117msostium CS RVA reset His pacing capture St A RVA pacing V AV fast/slow AVNRT SVT1 ISP ms SVT2CL 265msAH 97ms proximal HRA ATP2mg 20 Halo SVT2 ATP AT SVT2 AFL fast/slow AVNRT ATAFL 1 ATP H /58mmHg198bpm12 198bpmwide QRS tachycardia DC 192bpm narrow QRS tachycardia ATP bpm LBBB wide QRS tachycardia180bpmnarrow QRS tachycardia VA jump 2 Ensite Navx system 150bpm narrow QRS tachycardia fast slow ATP 1

8 His ablation45 ablationmapping 50 verapamil ablation 2 VAfast slow AVN pacing HRA double pairedjump up 1echo slow pathway ablation jump up 52 verapamil 2A ablationjump up jump up pacing 1 12 clinical Activation MapEn Site Navx His ablation verapamil ablation His ablation Navx Mapping ICD EPS 2nd session Navx Mapping //3 Mitral AT Crista AT CommonAFL/Reversed commom AFL Isthmus Navx Mapping Mapping

9 2 incisional reentrant atrial tachycardiaat AfCA incisional reentrant AT MVP AFListhmus CA AfAT 24 7 CA Af EEPVI AT isochronal map incisional reentrant AT lateral isthmus AT CA MVP 23 Af 24 7 CA EEPVIAT incisional reentrant AT AFL isthmus MRI EPS post pacing intervalppi RA PPI tachycardia cycle length TCLCARTO system RA activation RA centrifugal RA LA PPI PPI TCL LAactivation LA voltage LA 1.5mV Mitral annulus 5 double potential fragmented potential PPI TCL EPS

10 Cavo tricuspid isthmus isthmus dependent atrial flutter cavo tricuspid isthmuscti Carto system AT1 169bpm focal discharge pattern AT2 165bpm CTI AT3 164bpm CTI post pacing interval CTI 9 ATPIesaka AT SVT firingsvt SVT ATP4mg ATPHis Iesaka AT His RFCA RFCA His RFCA RFCA Iesaka AT1

11 P 60ms Narrow QRS tachycardia 3 2 ATP / isoproterenol 2 AT1AT2AT1isoproterenol His 200/ ATP3mg ATP AT2isoproterenol 215ms 21 AT2 AT1 AT2 2 ATP

12 1 EF VT AT AT AT3D AT1 AT2 AT3 AT 2 VTVT 3D VT VT CS sequence CSCS Navister Thermocoolmitral isthmus line 20W10 CS burstat CS 55 H21 10 persistent af H23 6 H EPSCS burst ATCL230msclinical ECG CS sequence RA free wall PPI CARTO3 activation mapping mitral isthmus LA roof macro reentry AT roof lineblock LIPV mitral isthmus CS LA block

slow pathway AVNRTablation1 74 H246 8 20 PSVT 9 3 PQ 400msec I HR50 AH 332msec slow pathway VA His decremental conduction AV node fast pathwayiav blockpac1psvt RAOD PAC PSVT HisPVC reset on set PAC

13 slow pathway AVNRTablation1 74 H PSVT 9 3 PQ 400msec I HR50 AH 332msec slow pathway VA His decremental conduction AV node fast pathwayiav blockpac1psvt RAOD PAC PSVT HisPVC reset on set PAC AH PSVT RAOD slow fast AVNRT AVNRT TV CSOS liner ablation TV CSOS floor liner ablation PSVT PSVT PSVT slow pathwayavnrt TV CSOS floorliner ablation AV block 1 AV SP NCC AV LCP fast slow AVNRT SPSPNCC 68 AVN VA ms Hlong RP WenckebachAV VA ATP6mg VA H PAH jump up P H AV AVN LCP

14 1 73 PSVT CS Halo distal jump up PSVT nodal pattern slow kent mapping Halo distal mapping CARTO CS roof proximal to distal patternbottom Halodistal to proximal patterncs PSVT HAV pattern slow fast AVNRTslow pathway1 echo session CS pitfall 1 Navix PQ 330ms 1 HIS HIS AH 163ms 2 HIS HIS in put 2 Navix HIS 2 slow pathway AH 2 Navixinput mapping

15 PJRT / narrow QRS tachycardia EF30 ATP20mg 50mg P 2 370ms His AA reset 5 AH 170ms PJRT PJRT incessant slow pathway 1 DDD 8 slow pathwaya H PSVT EPS AVNRTslow pathway A H junctional beat rate ms 2 pacing

1 78 150/min long RP 417 445ms pacing program burstah jump upah block reset burst fast slowlower common pathway WPW 1 32 WPW 1 2 10 1

16 /min long RP ms pacing program burstah jump upah block reset burst fast slowlower common pathway WPW 1 32 WPW H24H IIIIIaVf V1 IaVLMCV kent H EPS CAG mapping catheter AV ATP pacingsequence His resetavrt AV map AV PQS map AV PQS Kent

17 AFL EPS AFL gap narrow QRS tachycardia His VAV 115ms AVNRT Koch AVNRT A V AVNRT PLSVC AVNRT Coumel 1 31 AVRT wide QRS narrow QRS 417ms144bpm 537ms112bpm Narrow QRS AH 150ms 382ms jump up Narrow QRS fast pathway slow pathway fast pathway slow pathway Coumel AVRT

18 His WPW1 His AP APP AP His V1 QS IIIIIaVF His A V 60msAVAPP His V His His AP AVRT AV AV His APP APP QS 20W 2.5 His His APP AP AP AVRT 1 34 PSVT RVpacing ISP RV pacing APISP AP AP PSVTISP PSVT RV pacing AP AVRT AP RV pacing1 ISP AP

19 1 CS os 2 1 Koch mid Holter incessant long R P CS os jump up Isoproterenol ATP long R P 1 Wenckebach Mobitz II / PQ 320ms 1 WenckebachMobitz II2 ATP AH His Slowintermediate 100/ 1 1 Wenckebach DDD

20 ISPWPW1 59 HRA HISCSRV Baseline SCL msAVB380ms VACRV680ms RVc 680VA VABCS CSos HIS HIS ABCL 800ms RVRVext 800 CI360ms VA VABAVC HRAext 600 jump up CI ms CSos A ISP SCL 540ms RVc VACCSos A HIS A RVext 600 CI 280ms VA VABAVC HRAext 600 jump up CI 300ms 290ms 300ms CSos A HISRV AVAP AV 35W55 C RVc600ms 5 VAC ISP VACRVext500jump up AV AP ISP AP Jump up bpmnarrow QRS T P ATP10mg jump up CSO ATP His 6 jump up CSOjump up Jump up

21 EbsteinWPW WPW Ebstein IaVL IIIIIaVFV1 rs 2 6 EbsteinWPW 1 2Fr 4 twin valve 5Fr long sheath / EPS 2Fr 4P twin valve 5Fr 3punctureEPS/ABL / EPS/ABL 3 5Fr long sheathmedikit 2Fr EP star 3 Japan LifelineHis 4Fr 10PSt. Jude MedicalABL 5Fr ABLAZE Kids Japan Lifeline kg Fr EP star His 2 EP star sheath 3puncture EPS/ABL Yconnector EPS/ABL

22 1 scar critical isthmus V1P 260ms ball EPSCS distal proximal EnSite voltage map activation map low voltage zonedouble potential scar critical isthmus Isthmus 1 P280ms V1dome and dart circuit EPS 2 CTIentrainment pacing CTI 751 AFL 6 AFL 1FCL 245msF IIIIIIaVLaVFV1 EnSite Navx TVA AFL 1 entrainment pacing post pacing intervalppi TVA FCL 20msec CTIFCL 30 50msec AFL 2 FCL 260msEnSite Navx AFL 1 TVA AFL 2 entrainment pacing PPI CTI AFL 2 AFL 1 irrigation cathetercti CTI block line CTI block AFL 1AFL 2 AFL 12 EnSite Navx AFL 1 CTI PPI AFL 2 PPI FCL

23 bpm bisoprolol diltiazem bpm V1 Navix Velocity passive entrainment pacing PPI 15msec CT 84 CKD wide QRS tachycardia ADL CARTO CS

24 8mm fragmented potential line CTI dependent AFL1 JR 78 cavotricupsid isthmuscti entrain post pacing interval Electro anatomical mapping CTI 8mm tip CTI line double potentialfar field potential Electro anatomical mapping 4mm tip line mapping tiny fragmented potential CTI Large tip mg100mg 9 242ms CARTO 3

25 Pacemaker 83 OMIHV block Dual chamber pacemaker 11 organizeaa 220msec upper tracking rate 140bpm backup rate50bpm PVARP EF35 30 IIIIIaVF EnSite NavX 15 OMI CRTD upgrade ADL QOL flutter MVFL MVFL Trigger APC APC MVFL MVFLblockline EEPVI MVFLAblation MVFLMV lateral MV Isthmusblockline EnSite NavX mapping SLO Coolpath Agilis Agilis MVFL mm E`7.4E/E`12.5CS PVI Agilis 3 MVFL 2 2 MV Blockline MV Isthmus blockline 84.6

26 / ms post pacing intervalppi PPI Ensite Navx activation mapping fragment potential PPI 1 1 wide QRSASD1 NTT 41 22ASDupper sinusvenosus type ATP / 161 Wide QRS C WPW IV1aVF EPS CS AFL wide WRS clockwise common AFL uncommon AFL NavX activetion map AFL wide QRS

$isthmus crista terminalis 227ms EnSite NavX system 3D mapping Crista terminalis EPS Crista terminalis PPI Crista terminalis 135ms fractionated potential critical isthmus Crista terminalisupper loop$

27 Common atrial flutterupper loop reentry atrial flutter dual loop reentry CABG 46mm BNP 120pg/ml 229mscommon atrial fluttercommon AFLEPS common AFL Isthmus blockline blockline cavotricuspid isthmus crista terminalis 227ms EnSite NavX system 3D mapping Crista terminalis EPS Crista terminalis PPI Crista terminalis 135ms fractionated potential critical isthmus Crista terminalisupper loop reentry AFLCrista terminalis common AFL common AFL upper loop reentry AFL dual loop reentry 16 CFAEfocal AT1 focal QS CFAE CFAE AT CFAE 7 AT235msec ms AT

28 3 Macro reentrant AFLfocal AT1 52 AF defragmentation AF 2nd defragmentation RSPV MA AF/AT 3rdAF CL286msATCARTO systemperimitral AT CL384ms LA roof dependennt AT LA roof RSPV MA AF RSPV MA CL340ms ATCSos centrifugal pattern fractionated potential CSos AF/AT AF 3 Exit block 1 90ms Ablation Exit block ablation pilsicainide ablation ablation ablation

29 1 65AF PVI 2 RSPV 2 6 AT3 3 RSPV 180ms RSPV 2 1 AF RSPV RSPV RSPV PPI TCL RSPV 1 RSPV RSPV AT RSPV PVI 2 RSPV 1 RSPV RSPV 1 PVI PV trigger driver1 200msec 140msec RIPV RSPV RIPV trigger RSPVdriver 60 blocked APC RSPV RIPV RIPV blocked APC RSPV RIPV 240msec 150msec RSPV

1 49 2011 11 AF LSPV LIPV AF triggerfiring LS/LIPV RSPV RIPV RSPV iso rhythmic RSPV12P

30 AF LSPV LIPV AF triggerfiring LS/LIPV RSPV RIPV RSPV iso rhythmic RSPV12P RSPV RSPV firing RSPV RS/RIPV RSPV warm up ATP RSPV ATP RSPV 1 driver ms 120ms 250ms 90ms

31 firing AF firing 2 AF 17 ISP ATP firingafatp firing AF AF ISP 200ms AT 5 AFAT3 PAC ISP AF AT PAC 1 sequence PAC Activation map 45ms PAC focus flecainide 10 isoproterenol Activation map

32 DEX 9 DEX 0.5g/kgDEX 1.0 g/kg3 DEX g/kg10 OAA/S g/kg/hr 0.2mg/kg bolus 0.5 g/kg 9 3 DEX 2 DEX ABL AF AF 1 AF AF PM 62 AF AF Holter 5 AF ABL PVIPVI AF PM PM

Maze Complex Fractionated Atrial Electrogram 1 Complex Fractionated Atrial Electrograms CFAE Maze CFAE 1 65 1988 1998 2002

33 Maze Complex Fractionated Atrial Electrogram 1 Complex Fractionated Atrial Electrograms CFAE Maze CFAE rate control Maze Inferior GP IRGP 1 7 IRGP IRGP 58 2 AF AF TIA AF GP 5 GP AFILGP 4 IRGP 6 AF IRGP

34 EPA/AA eicosapentaenoicacid EPA/arachidonic acid AA EPA EPA/AA EPA/AAatrial fibrillation AF angina pectoris AP 3 n 101 n 103 n 116 EPA/AA EPA/AA AF AP vs p 0.035p 0.025AF AP EPA/AA AF p0.01EPA/AA focal Af mm CS AA ms 8 isolation CS AA ms CFAE ablation mapping CFAE regular AA ms driver Lasso Lasso roof AA Lasso LSPVridge focal Af

35 CFAE vs vs cm/secP0.48 vs vs cm/secP CT3D Ab CT 3 3DM E E CT CT Ab E E Ab CT Ab E Ba N BaE 3DM E E 3DM Ba 3DM E mm Ba mm Ba 3DM P 0.01 Ba E 3DM5 16 Ba /2 E 3DM Ba mm P 0.05 Ab E 3DM 3DM E 2cm E

AF LPV LPV 100J cardioversioncv LPV LPV 150JCV LPV LPV

36 1 68 CL260ms blockline firing 2 1 AT RSPV lasso78 triggered activity1 DC 4 AF PV triggered activity 71 PAF AF LPV LPV 100J cardioversioncv LPV LPV 150JCV LPV LPV pacing LPV LPV triggered activityrpv ATPLPV dormant conductiondc

37 PVI 41 PVI EPS EPS PVI 72.2 PVI 80.0 P PVI EF vs P AHI 22 15vs35 14 P PVI vs P AHI

38 exit block r 0.27 p BM index 0.26 p p 0.025total radiofrequency energy SD BM index total radiofrequency energyr 0.31 p

39 rs SNP rs rs Risk HighIntermediateLow mm High 92/ Intermediate 115/ Low 24/ LowHigh Intermediate 89.6 Low 50 rs CARTO3 CARTO ABL CARTO3 CARTOSOUNDAf ABL 24 1 Af ABL CT Merge Contour

40 83mitral line catheter Maze 8 PVI 3 mitral lines multiple wavelets segment 8 PVI 1 box isolation 1 8 PVI AF 69n 7744 n 43 5 n 20 PVI35n 5216 n 325 n 32 8 PVI AF 3 segment PVI 3 3 mitral lines 3 mitral lines segment mitral line AF 8 3 lines AF 88 n n 43 25n 20CFAE segment 1 mapping PVI PVI roof linemitral isthmus line mm 21NavXPVI roof line mitral isthmus line mapping blocklinemapping roof line 3274mitral isthmus line29 67 blockline Mapping mapping point pointGap roof line mitral isthmus line roof line 41 95mitral isthmus line 4298 blockline roof line mitral isthmus line mapping line gap blockline

41 Intercaval line AF AF AF AF AF AF AF AF AF AF AF AF AF AF Intercaval line AF AF AF Intercaval line CARTO SOUND1 CARTO SOUND 52 CARTO SOUND MRI CARTO SOUND geometry CARTO SOUND Gy 6

42 point by point C point by point P 42 C 21P 21 line roof line mitral isthmus line C vs249 59p 0.01C vs p 0.01 C vs p 0.01Lineroof line 100 vs 90mitral isthmus line100 vs 95 blockline 1 46 EF 33 2 defragmentation 210msec 193msec163msec CFAE 198msec 310msec

43 ICD8malignant idiopathic RVOT VTVF 398 ICD 3 polymorphic VT ICD6 ICD VT ICD PVC VT RVOT origin EPS PVC activation mappingrvot septum PVC VT RVOT origin idiopathic PVCVT VF polymorphic VT malignant entity ICD ICD / PVC LVDd 61mmLVEF 38 PVC PVC V6 s avl/avr 1.27PDI 0.58 GCV QRS 18ms GCV QRS 28ms 350 GCV GCV GCV QRS 20ms W 3 GCV LVDd 52mm

44 VT RFCA VT RFCA RFCA VT VT/VPC I V5V6S 2 3 VPC VT/VPC 2 1 VT/VPC VT VT RFCA VT isolated prepotential Purkinje trigger IVF ICD 3 ICD 4 J ST QTKCNQ1 KCNH2SCN5A 6 LBBB 340ms PVC PVC LBBB Purkinje PVC QRS30ms Pacemap PVC acceleration Purkinje network PVC Purkinje edrophoniumatpisp PVC PVC 30/ICD Purkinje trigger 1

1 ICD RVOT VPCQRS140ms coupling interval 380 400msnoncontact mappingrvot VPC acceleration VPC RVOT VPC ICD 30 AED 12 BrugadaJ QT CT MRI VPC RVOT VPC

45 1 ICD RVOT VPCQRS140ms coupling interval msnoncontact mappingrvot VPC acceleration VPC RVOT VPC ICD 30 AED 12 BrugadaJ QT CT MRI VPC RVOT VPC noncontact mappingrvot VPC / PVC / PVC PVC V3mapping pacemap PVC mapping PVC 20msec. pacemap mapping PVC PVC acceleration PVC PVC PVC 1

46 L RCC V1 qrs PVC PVC V3V2 R/S 0.39I V1 qrsholter PVC PVC burden 35 NT probnp X CTR 62 EF 66 EPSmapping pace map PVC /mapping LCCRCCL RCC LCC QRS 22msec perfect pace map 1.5 PVC V1 qrs PVC L RCC Reversed polarity / EP Expert Doctors Team Tsuchiya / pace mapping local activation time mapping QS reversed polarity focal reversed polarity / Holter ECG / 6 NavX system geometryactivation mapping anterior attachment pace mapping 12/12perfect match QS polarity reverse 15 reversed polarity /

47 1 OT VT 6118 PVC V4/ PVCV3/4 23 VT RFCA PVC isoproterenolisp 20g/Hrphenylephrine100g V4/5 PVC 8 VT non sustained VTRFCA PVC ISP20g/Hr clinical PVCPVC1 edrophonium5mgphenylephrine50g PVC1perfect pacemap notchpvcpvc2 PVC1 PVC2 PVC firing PVC PVC OT VT2 RFCA / / 12 V1 V6 R R notching LAO 11 QS IV6morphology

48 wide QRS tachycardia ATP biphasic200j EPS PPI30msconcealed entrainment Purkinje potential 1 RVOT VPCs ABLVPCs wide QRS tachycardiarvot NSVT ABL 30 HR200 wide QRS tachycardia 12 ECG VPC V4IIIIIaVf R I S typevpc ISPCL266ms226bpmNSVT Mapping RVOT VPC QRS onset Bi polar 14msUni polar QS patternrvr VPCNSVT ISP VPCNSVT VPCNSVT

1 34 28 HR 180bpm ILVT 33 VT 3D mapping Purkinje VT 8 VT 0 QRS duration 100ms HR 180bpm Purkinje VT VT VT ILVT 2 1 1 EP Expert

49 HR 180bpm ILVT 33 VT 3D mapping Purkinje VT 8 VT 0 QRS duration 100ms HR 180bpm Purkinje VT VT VT ILVT EP Expert Doctors Team Tsuchiya VT 1 PVC/PVT 6 PVC PVC PVT PVC PVT 17 PVC PVC PVT 16 PVT PVC EnSite ArrayPVC QRS 30msec pace mapping 12/12 PVC PVT

CARTO SOUNDanatomy 1 ElectroanatomicalEAmapping/ anatomy CARTO SOUND anatomy 70 150bpm

anatomy 12 2 VT/VPC V2 R/S 0.38 vs. 0.57 and 0.61 transition zone V3III/IIaVL/aVR 1.0 1.

50 CARTO SOUNDanatomy 1 ElectroanatomicalEAmapping/ anatomy CARTO SOUND anatomy bpm VTA EA VT centrifugalbcarto SOUND VT QRS 25msec CD VT acceleration 5 EA CARTO SOUND anatomy 12 2 VT/VPC V2 R/S 0.38 vs and 0.61 transition zone V3III/IIaVL/aVR GCV VT/VPC VT/VPC CA VT/VPC / VT/VPCGCV CA CA GCV VT/VPC CA VT/VPC12 ECG 3 1 CA 1 1 GCV 1

51 Non reentrant focal purkinje VT NavX NSVT4 18 NSVT 1.9Mets NSVT 12 monomorphic VT VT sustained VTNon reentrant focal purkinje VTNavX system VT activation map NavX map pre potential pace map 12/12 perfect pace map VT non reentrant focal prukinje VTNavX system pilsicainide 1 2 isoproterenol pilsicainide isoproterenol pilsicainide / VT DC isoproterenol pilsicainide 8mg P1 purkinje P2 LV apex posterior septum

52 aorto mitral continuity1 aorto mitral continuityamc AMC 57 AMC 20ms AMC wide QRS 1 50 HR214/wideQRS 50mg HR 220/ wideqrs HR172/ narrowqrs MRI EPS AVRT wide QRSAVRT ARVCICD ARVC

53 wide QRS Purkinje NSVT KL KL6CT 2012 QRS 172ms NSVT NSVT His VT QRS CARTO mapping QRS 80ms high frequency low voltage QRS Purkinje potential pacing capture 90ms perfect pacemap NSVT NSVT Purkinje HCMICD VT stormablation HR 200/min VTDC 200Jsinus recover CAG LVG HCM ICD VT study ICD 12 2 lidocaine nifecarant blockersedationcontrol VT study Sinus Voltage mapping low voltage area RV burst VT VT mapping low voltage area mappingvt1/3 fragmentationvt VT2 VT5 VT5 VT VT 9 Low voltage area point ablation low voltage area VT liner ablation VT ICD

54 electrical stormpcps 1 Vf PCPS Vf PVC NSVT 29 Carto System scar scar border PVC V1 3 QS CAG #6 90#7 99 #11 75 #7 #7 PCI IABP 4 IABP 5 electrical storm PCPSIABP 105bpm Vf 6 1 VT P potentialpurkinje system low voltage area Purkinje potential VT 45 4 Seg 3 RCA dominant entrainment pacing CARTO 3 voltage mapping low voltage areavt activation mapping VT low voltage area pace mapping

55 VT storm PCPSIABP VTICD 200mg/VT storm PCPS IABP VT activation map CARTO substrate map VT substrate substrate map border zone clinical VT CL400ms QRS 64ms clinical VT exit exit border exit VT PCPS IABP VT 1 ARVC 63 VT VT 520ms Voltage mapping VT 3 VT 3 ARVC 1

56 VT ARVC12 HR200bpm sustained VTEPS Electro anatomical mappinng substrate mapping 2 low voltage arealva RFA100mg 5mg VT VT EPSRFA LVA scarscar fragment potential, late potential VT RFALVA scar sustained VT low voltage area VT VT VT non ischemic VT VT clinical VT VT2 122bpm VT3 70mmHg session VT

57 / VT MRI trabecula 6 CARTOvoltage map substrate map VT1 clinical VT / DC VT2 non clinical clinical VT VT3 VT1 VT1 VT3 lesion VT 7 VTCT MRI VT1VT3 trabecula VT2 ARVC DDD VT 320msEPS RFCA ICD ICD VT 420ms Substrate mapping isolated delayed potentialidpactivation mapping mid diastolic potential IDP 13

58 Purkinje 3 VT HCM OMI VT ABL 173 HCM 6 1 PVC EPS LVmapping LVA PVC/NSVT V Pace mappingperfect mapping ABL PVC 2 35HCM NSVT EPS LV mapping PVC/NSVT ABL VT 361 OMI VT EPS LV mapping NSVT V ABLVT focal ablation VT VT VT VT 352ms CARTO VT mapping QRS 135ms fractionatedentrainment pacing QRS QRS VTQRS VT QRS 26 focal ablation VT focal ablation

VT storm cryoablation1 fragment potential 2VT ablation cryoablation VT VT storm cryoablation HCM1 66 2001 10 1 HCM ICD 2011 9 10 VT storm 150/ VT 1 10 VT VT 2 11 origin delayed potential 1 52 20121

59 VT storm cryoablation1 fragment potential 2VT ablation cryoablation VT VT storm cryoablation HCM HCM ICD VT storm 150/ VT 1 10 VT VT 2 11 origin delayed potential ARVC 4 15 VT nifekalant VT 4 19 ARVC CARTO voltage map lateral side low voltage areaburst clinical VTnormal low voltage border VT VT VT VT activation map VT free wall delayed potentialdp VT origin DP ARVC 1

60 uncommon AVNRT 2 CTGA uncommon AVNRT CA CTGA uncommon AVNRT CA 2 SP CTGA5HBE uncommon AVNRT HBECSosAsp potential SP 2RastelliCTGA 32 CSHBE VA SVT Vpace lower common pathway SVT V entrainment VA PVC A resetuncommon AVNRTV pace mapping CA VA FP CTGA SP 1 CSos1 CTGA twinavncs SP CTGA SPCSos EbsteinWPW HR 191bpm. narrow QRS tachycardiast P 2.5mg WPW 20mm EbsteinWPW Kent Ebstein

61 Ebstein Ebstein2 EP Expert Doctors Team Tsuchiya Ebstein Ebstein WPW Ia EPS Ebstein WPW EPS 1 Ebstein 2 CARTO SOUND AVNRT1 49 PSVT ATP20mg cardioversion ASD RSPV RA CARTOSOUND QpQs3.16 CAR- TOSOUND RSPV AH81msHV37ms VACS os jump up entrainment VA AVParahisian pacing CS os AT lower common pathway fast slow AVNRT CS os slow pathway ASD AT Af AVNRT ASD CARTOSOUND 1

62 Double switch 1 ctgadouble switch substrate 19 ctga 8 Double switchsenning Rastelli 11 baffle leak sequence baffle 2 fragment sequenceisthmus concealed entrainmentpost pacing interval isthmus Double switchunstable Mustard dtgamustard isthmus 28 dtga 10 Mustard msec SR0 SR2 isthmus concealed entrainment post pacing interval isthmus Mustard

63 CARTO system substrate map CT cycle lengthcl230ms activation map CL post pacing intervalppimapping SVC PPI CT CL 250ms SVC CT PPI CL 310ms 2 140ms fragment potential CL reverse common AFL VIFVT substrate substrate DORV VIFVT substrate 34 DORV VT 3 VTDC Ablation Clinical VT RBBB Clinical VTVT1 VTCARTO system mapping VIF 3.5 VT1VT2.3 mapping VT1 VT4VT1 VIF mid diastolic potential VT4VT VIF VIF VT substrate

64 QOL QOL RFCA RFCA QOL 1 4 EP WorkMate Ensite EP WorkMate WM HISRIS WM HISRIS WM 1HIS RIS 2RISWM 3WM 4RIS RIS HIS RIS His WM WM Ensite PACS

CARTOSOUND land mark AF 2012 4 CAR- TOSOUND 3D CT carina land mark surface registration AF CARTOSOUND land mark Ao AF 8 67.0 6.1 5 5 electro anatomical 30.4 0.

65 CARTOSOUND land mark AF CAR- TOSOUND 3D CT carina land mark surface registration AF CARTOSOUND land mark Ao AF electro anatomical EA CARTOSOUNDland marksurface registration Ao CT EA CT mm 0.07mm 3.72mm Ao mm 0.03mm 5.67mm AF CARTOSOUNDAo EA EP Navigator EP Navigator47 CARTO p 0.05EP Navigator CT EP Navigator mGy mGyp CT 25 EP Navigator CT 3DCARTO EnSite/NavX system CT 3 EP Navigator 3 2 X 3

CTCARTO MERGE CT CARTO MERGE 70 19 64 MDCT CT CARTO CARTO MERGE 69 RFCA 40mm 1puncture3sheath CSHIS catheter Mapping EnSite Navx ring catheter2010 PV potentials 8mm tip catheter EEPVIPV

66 CTCARTO MERGE CT CARTO MERGE MDCT CT CARTO CARTO MERGE 69 RFCA 40mm 1puncture3sheath CSHIS catheter Mapping EnSite Navx ring catheter2010 PV potentials 8mm tip catheter EEPVIPV isolation EEPVI ring catheter PV potentials bottomroofline bottom PV isolation catheter irrigation catheter line line PV isolation carina PV potentialsisolation ATP40mg dormant conduction approach

67 3MRIImage Integration 3 3 MRI Image Integration 3 CT CT MRI CARTO3system import segmentation 1.5 MRI 32 SSFPMRI SJM A/D HIOKI 3 /

68 Ensite Velocity AF RFCA ME AF 3D Electro Anatomical mappingensite Velocity Open Irrigated Tip CatherCool PathTMEnsite Velocity kg kgP Ensite Velocity 7 Sensitherm TO OSYPKATO 10.5Fr TO SJM Sensitherm7Fr Sensitherm FINDER TO63 Sensitherm 36 TO Sharp Sensitherm Dull Sensitherm TO 11 Sensitherm 1 Sensitherm TO

69 ST WPW1 75 CS kent AVRT ST W50 60 CS kent ST Cavotricuspid isthmusctilinear ablation PAVB ABL PQ 144ms QRS 97ms ABL NavX velocity ABL PAVB 4 10 PAVB PAVB ABL EPSAH120msHV 37msHR200bpm Wenckebach rate50mg HV 40ms valsalva ABL ABL CTI ABL 1

70 ST segment Multidetector CT Brockenbrough ST ST 3 2 ST 3 1 ST 3DEnSite NavX NPPV NPPV PS EPAP BiPAP autosv Advanced BiPAP autosv Advanced NPPV

22...J.e.A.u.Q01-07_.O.t

22...J.e.A.u.Q01-07_.O.t 113:00~14:00 The Value of Electrogram Analyses in Defining Arrhythmia Mechanisms-Implications for Catheter Ablation Melvin M. Scheinman University of California San Francisco, USA 1 112:00~13:00 Next Generation