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[Music] good afternoon i am giving a talk today for the heart failure service on pt in heart failure here you can see the schematic of a clinical course of a heart failure patient which obviously starts as you know with uh left ventricular dysfunction which may be symptomatic uh then a patient develops symptomatic heart failure at any given time they may develop sudden cardiac death thats usually more common before the heart failure decompensation and before the pump failure occurs but to be clear it can happen at any time ill talk a little bit about ventricular thick area in the setting of structural heart disease and particularly heart failure ventricular they carrying the settings of of structural heart disease is most commonly caused by scar-related re-entry most commonly in ischemic heart disease you have a myocardial scar from my previous myocardial infarction and because their scar is not completely homogeneously fibrotic tissue you have strands of viable tissue mixed with the