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Background In the large randomized trials evaluating patent foramen ovale (PFO) closure vs. medical treatment in secondary prevention of stroke, the incidence of atrial fibrillation has been reported more frequently with PFO closure (2.9–6.6%) than with medical treatment (0.4–1.9%). These episodes were clinically reported and may not reflect the real incidence detected by prolonged ECG recording. Purpose To evaluate the incidence and timing of supraventricular tachycardia (SVT) after percutaneous PFO closure. Methods Prolonged cardiac monitoring was proposed to patients undergoing PFO closure at the tertiary center of Pitié Salpétrière Hospital, Paris. According to the estimated risk of SVT, two different approaches were used to monitor cardiac rhythm. A 3-year permanent recording using REVEAL™ XT or LINQ was proposed to high risk patients (age >45 years, multiple CV risk factors, prior palpitations or supraventricular ectopic activity during Holter monitoring prior to the intervention). A 4-week, 15-lead ECG continuous recording using the patch-free, wire-free, wearable Cardioskin™ system was proposed to lower risk patients. Endpoints of interest were the occurrence of SVT episodes (>30 seconds) and unplanned medical consultation or hospitalization for this reason Results From October 2018 to January 2020, a total of 64 patients underwent prolonged ECG monitoring including 32 (50.0%) and 32 (50.0%) patients with Cardioskin™ and REVEAL™ systems, respectively. A SVT was recorded in 11 (17.4%) patients, including atrial fibrillation (AF) in 6 (9.5%) patients. The median delay of SVT occurrence was 33.0 (14.0–39) days after the procedure (Figure 1) and 18 (10.8–34.8) days for the 6 patients with AF. Unplanned hospitalization or emergency medical visit for symptomatic SVT occurred in 5 (45.5%) patients. Antiarrhythmic medication and oral anticoagulation were initiated in 10 (90.1%) and 7 (63.6%) of the 11 patients, respectively, and SVT recurrences were recorded in 5 (45.5%) patients. No stroke was reported in any of the 11 patients during follow-up. There were no significant differences with respect to baseline and procedural characteristics among patients with or without SVT during follow-up. Conclusion Atrial tachycardia is frequent (17.4%) after PFO closure and long-term continuous ECG recording suggests that the incidence is higher than the clinical episodes reported in the randomized trials. This arrhythmic complication of PFO closure seems limited to the first 4 months following the procedure. Larger studies need now to confirm our findings. Figure 1 Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): ACTION coeur

Resume Contexte L’hypercholesterolemie familiale (HF) est une maladie genetique frequente qui expose a une atherosclerose precoce, en particulier coronaire. Cependant, l’HF reste encore meconnue des cardiologues et est largement sous-diagnostiquee en France. Elle doit etre suspectee pour des taux de LDL cholesterol (LDLc) ≥ 1,9 g/L en l’absence de traitement. Objectif L’objectif de cette etude multicentrique retro- et prospective etait de preciser la prevalence des patients admis en USIC avec un taux eleve de LDLc et l’impact sur leur suivi lipidique personnel et familial. Methodes Analyse retrospective de tous les bilans lipidiques preleves a l’admission en USIC dans 4 centres en 2017. Analyse descriptive des caracteristiques demographiques, des motifs d’hospitalisation et du statut coronaire des patients consecutifs avec taux de LDLc ≥ 1,9 g/L (4,9 mmol/L). Suivi prospectif a un an portant sur le traitement hypocholesterolemiant, le suivi biologique et l’existence d’un depistage familial de l’HF. Resultats Un dosage de lipides a ete realise chez 2172 patients et 108 (5 %) avaient un taux de LDLc ≥ 1,9 g/L (âge moyen 64 ± 14 ans, hommes 51 %). L’hospitalisation etait liee a un syndrome coronaire aigu dans 78 % des cas et une cardiopathie non ischemique dans 22 %. Un traitement hypocholesterolemiant etait prescrit chez 9 % des patients a l’entree et 84 % a la sortie, par fortes doses de statine. Au suivi a un an, 20 % n’avaient pas controle leur LDLc, la statine avait ete diminuee (36 %) ou arretee (7 %) chez 43 %. Au moins un relatif du premier degre (fratrie ou enfants) avait eu un dosage de cholesterol dans 37 % des cas, et l’exploration genetique a ete realisee chez 3 patients. Conclusions Le depistage de l’HF en USIC necessite le calcul systematique du score DUTCH chez les patients a risque dont le taux de LDLc est superieur a 1,9 g/L, ce critere biologique n’etant pas suffisant en soi. Cette etude montre qu’il existe une marge importante d’optimisation de la prise en charge therapeutique et de l’exploration familiale chez les patients a risque d’HF depistes en USIC.

Familial hypercholesterolemia (FH) is a frequent genetic disorder that leads to premature atherosclerosis and coronary artery disease. However, knowledge of FH by cardiologists is weak, and FH remains underdiagnosed in France. FH should be suspected when low-density lipoprotein cholesterol (LDLc) levels exceed 1.9g/L (4.9mmol/L) without lipid lowering therapy.This multicenter retro- and prospective observational study aimed at estimating the prevalence of high LDLc levels in patients admitted in coronary care units, and the impact for the personal and familial follow-up for lipid status.Retrospective analysis of all plasma lipid measurements performed at admission in coronary care unit of 4 hospitals in 2017. Retrospective analyses of demographic, clinical, and coronary data of consecutive patients with LDLc levels≥1.9g/L. Prospective 1 year follow-up focused on lipid levels, treatments, and personal and familial screening for FH.Lipid measurement has been performed in 2172 consecutive patients, and 108 (5%) had LDLc level≥1.9g/L (mean age 64±14 years, men 51%). The primary cause of the hospitalisation was acute coronary syndrome (78%), and 22% of patients were free off coronary artery disease. Lipid lowering therapy was present in 9% of patients at admission, and 84% at discharge, with high statins regimen. At 1-year follow-up, control of LDLc level was not performed in 20% of patients, and statin dose was decreased (36%) or withdrawn (7%) in 43%. Lipid measurement has been performed in at least one first degree relative in 37% of patients, and genetic exploration has been done for 3 patients.Screening of FH in CCU should be routinely performed using the Dutch Score when LDLc is above 1.9g/L. Individual and familial management of patients at high risk for FH screened in CCU should be optimized, both for diagnosis and therapeutic purposes.

Background Familial hypercholesterolemia (FH) is a frequent genetic disorder that leads to premature atherosclerosis and coronary artery disease. However, knowledge of FH by cardiologists is weak, and FH remains underdiagnosed in France. FH should be suspected when low-density lipoprotein cholesterol (LDLc) levels exceed 1.9 g/L (4.9 mmol/L) without lipid lowering therapy. Purpose This multicenter retro- and prospective observational study aimed at estimating the prevalence of high LDLc levels in patients admitted in coronary care units, and the impact for the personal and familial follow-up for lipid status. Methods Retrospective analysis of all plasma lipid measurements performed at admission in coronary care unit of 4 hospitals in 2017. Retrospective analyses of demographic, clinical, and coronary data of consecutive patients with LDLc levels ≥ 1.9 g/L, whatever the reason for hospitalisation. Prospective 1-year follow-up focused on lipid levels, treatments, and personal and familial screening for FH. Results Lipid measurement has been performed in 2172 consecutive patients, and 108 (5%) had LDLc level ≥ 1.9 g/L (mean age 64 ± 14 years, men 51%). The primary cause of the hospitalisation was acute coronary syndrome (78%), and 22% of patients were free off coronary artery disease. Lipid lowering therapy was present in 9% of patients at admission, and 84% at discharge, with high statins regimen. At 1-year follow-up, control of LDLc level was not performed in 20% of patients, and statin dose was decreased (36%) or withdrawn (7%) in 43%. Lipid measurement has been performed in at least one first degree relative in 37% of patients, and genetic exploration has been done for 3 patients only. Conclusions Screening of FH in CCU should be routinely performed using the Dutch Score when LDLc is above 1.9 g/L. Individual and familial management of patients at high risk for FH screened in CCU should be optimized, both for diagnosis and therapeutic purposes.

Introduction L’angioplastie coronaire est un challenge quotidien. Depuis son avenement dans les annees 1980, bon nombre de progres a ete realise notamment grâce aux stents actifs, nous permettant d’etendre les indications d’angioplastie. Il demeure certaines limites, mais quel est le meilleur moment pour referer le patient au chirurgien ? Observation Une patiente de 62 ans, hypertendue, diabetique non insulino-requerante, tabagique active et obese, est adressee au service pour coronarographie diagnostique devant une dyspnee d’effort stade 2 de la NYHA et une scintigraphie myocardique positive en apical. La coronarographie realisee par voie radiale droite 6 French, retrouve un reseau de dominance droite, un atherome ectasiant et une lesion monotronculaire de l’IVA moyenne. Il s’agit d’une lesion tres calcifiee de 10 mm de long. Une premiere tentative d’angioplastie est debutee ad hoc. Nous decidons d’arreter la procedure devant la persistance d’une empreinte lors de l’inflation d’un ballon non compliant de 3,5 mm malgre l’utilisation prealable de fraises d’atherectomie rotative de Rotablator de 1,25 et 1,75 mm. La patiente etant parfaitement stable nous programmons, 3 semaines plus tard, une nouvelle tentative d’angioplastie apres avoir commande le materiel adequat. Nous sommes confrontes a un nouvel echec malgre l’utilisation d’un Rotablator de 2 mm et de Cutting Ballons de 3,5 et 4 mm. Nous decidons alors de tenter une troisieme angioplastie apres avoir commande une fraise de Rotablator de 2,5 mm. Nous realisons au prealable un Coroscanner pour comprendre le mecanisme de cette lesion indilatable. Nous mettons alors en evidence un anneau calcaire de l’IVA moyenne dont la lumiere fait 2 mm. Cette procedure a lieu dans notre centre chirurgical referent. Cette fois nous faisons face a un echec de l’utilisation de la fraise de 2,5 mm, qui ne passe pas dans les sondes de 8 French. La solution vient finalement de l’utilisation d’un Cutting ballon le plus court possible (6 mm de long par 3,5 mm de diametre) mene a haute pression (22 atm) lors d’une inflation prolongee (> 1 minute). Discussion L’utilisation de l’atherectomie rotative ne date pas d’hier puisqu’elle a ete mise au point par D. Auth en 1987. La possibilite de mordancage de la plaque calcaire (epargnant le tissu sain) a l’aide d’une fraise en rotation a tres haute vitesse (180 000 tr/min), recouverte de microparticules de diamant, en fait une arme majeure dans l’abord des lesions resistantes. Neanmoins, il est exceptionnel d’utiliser des fraises de diametre superieur a 1,75 mm, il en resulte un challenge technique supplementaire. De nouveaux outils se developpent dans ces indications, tels que les ballons a double paroi capables de supporter de tres hautes pressions (plus de 30 bars), venant etoffer notre arsenal d’angioplastie. Cependant, il ne faut pas oublier le risque lie a de telles procedures et l’angioplastie coronaire ne saurait remplacer la chirurgie de pontage coronaire. Conclusion Nous presentons un cas d’anneau calcaire stenosant de l’IVA moyenne particulierement resistant. L’emploi de Rotablator de 2 mm et de Cutting ballons courts, portes a hautes pressions, lors d’inflations prolongees nous a permis de proposer a cette patiente une alternative au mono-pontage de l’IVA.