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Online Appendix for the following JACC: Cardiovascular Imaging article
TITLE: Real-Time Integration of MDCT-Derived Coronary Anatomy and Epicardial Fat: Impact on
Epicardial Electroanatomic Mapping and Ablation for Ventricular Arrhythmias
AUTHORS: Carine F. van Huls van Taxis, MD, Adrianus P. Wijnmaalen, MD, PHD, Sebastiaan R.
Piers, MD, Rob J. van der Geest, PHD, Martin J. Schalij, MD, PhD, Katja Zeppenfeld, MD, PHD
Figure 1: Bull’s eye reconstruction color coded for epicardial fat thickness
The 24 segments epicardial bull’s eye reconstruction with 8 short axis segments and 3 long axis
segments. For each segment the mean epicardial fat thickness (mm) is indicated. The basal and
apical anterior RV wall and the basal superior LV wall showed the thickest epicardial fat layer (56±3mm).
Figure 2: Comparison of gross pathology with MDCT derived data
In this case ablation was successfully performed without acute complications despite the vicinity
of a coronary artery; the patient was in cardiogenic shock because of incessant VT and died 6
weeks later due to progressive heart failure. No coronary artery lesion could be detected at
autopsy.
Panel A: Gross pathology of the heart. Panel B: Final fusion image. Panel C: Fusion of the multidetector computed tomography (MDCT) anatomy with the epicardial electro-anatomical voltage
map in a modified anterolateral (top) and posterolateral (bottom) view. The ablation site in the
vicinity of the circumflex coronary artery is indicated. Comparison of panel A and B shows a good
correlation between epicardial fat distribution by pathology and the MDCT derived epicardial fat
mesh (white dotted lines). The black line indicates the atrioventricular groove; the anterolateral
low voltage area (color coded as indicated) is compatible with subepicardial scar in the absence
of epicardial fat.
LV=left ventricle, RV=right ventricle, RVOT=right ventricle outflow tract.