Cardiac Imaging in abnormal rhythm Role of MDCT

Cardiac Imaging in abnormal rhythm Role of MDCT Cardiac Imaging in abnormal rhythm Role of MDCT Scope of the problem CT in Atrial Fibrillation CT and pacing Ventricular arrhythmia Other applications 1

Arrhythmia Epidemiology: Affects > 14 million people in US > 800,000 annual hospital visits in US Some are immediately life threatening Sudden cardiac death - acute or remote MI 500,000 deaths per year in US Other are not immediately life threatening Important complications, such as stroke the annual mortality rate per 100,000 people from atrial fibrillation and flutter in Egypt has increased by 143.2% since 1990, an average of 6.2% a year. Though this has been the trend overall, adjust the filters at the top of the visualization to see how the mortality rate for atrial fibrillation and flutter has changed over time for men and women of specific age groups in Egypt. Global Burden of Disease Study (ghdx.healthdata.org). 2

Scope of the problem CT in Atrial Fibrillation - before and after pulmonary vein ablation - Assessment of LAA before percutaneous occlusion CT and pacing Ventricular arrhythmia Other applications Atrial Fibrillation Cardiac CT is useful prior to and after ablation Evaluate pulmonary venous anatomy prior Navigation guide during ablation Evaluate complications after ablation 3

Atrial Fibrillation Cause: Treatment: Ablation techniques for AF 4

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Pre-ablation Role of Imaging During ablation?? Post-ablation PV ostial mean diameter Pre-ablation: Sizing Length of trunk: Early branching 6

Pre-Ablation :variations 7

Fly through images 8

Pre-ablation: Esophagus location 9

Pre-ablation: Esophagus location Pre-ablation: Esophagus location Layer of adipose tissue may insulate the esophagus from thermal injury 10

Left Atrial Appendage Filling Defects True thrombus Pseudo-thrombus: Solution of this problem???? 11

Post-Ablation : Complications Pulmonary Vein Intrathoracic Other Cronin,Acad Rad 2004 Post-Ablation: pulmonary vein stenosis 12

Post-Ablation: pulmonary vein stenosis European Heart Journal, Volume 31, Issue 22, 1 November 2010 Post-Ablation: esophageal fistula 13

Post-Ablation: esophageal fistula Circulation: Arrhythmia and Electrophysiology. 2013;6:675-681 Originally published August 20, 2013 14

Scope of the problem CT in Atrial Fibrillation - before and after pulmonary vein ablation - Assessment of LAA before percutaneous occlusion CT and pacing Ventricular arrhythmia Other applications 2. Assessment of LAA before percutaneous closure 15

Steps for LAA before percutaneous closure Steps for LAA before percutaneous closure 16

Steps for LAA before percutaneous closure 17

Follow up after percutaneous LAA closure Scope of the problem CT in Atrial Fibrillation CT and pacing: imaging before implantation, during, safety Ventricular arrhythmia Other applications 18

BiV pacing and imaging of coronary sinus and coronary venous system 19

Safe included 516 CT scans (332 defibrillators, 184 pacemakers) primary outcome Secondary endpoints 20

none no differences none no differences SAFE 21

Goals of CT Define anatomy LV thickness scar (( CT?? MRI)) September 2017, 22

Abnormal perfusion was defined as myocardium exhibiting significantly reduced contrast distribution visually compared against attenuation of normal myocardium in each patient used as an internal reference September 2017, September 2017, 23

Results CT-SQUEEZ derived targets Conclusion CT-SQUEEZ derived target selection to predict the optimal venous site for LV lead placement in patients undergoing CRT upgrade. September 2017, Turn off arrhythmia correction, trigger 45% Most important step is recognition 24

Summery CT in Atrial Fibrillation - before and after pulmonary vein ablation - Assessment of LAA before percutaneous occlusion BiV pacing: imaging before implantation, safety Ventricular Arrhythmia Before RF ablation -anatomy : LV thickness, Location of previous MI, scar (MRI) new applications : before CRT 25

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