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International audience; Aims: The aim was to assess the effect of a telemonitoring programme vs. standard care (SC) in preventing all‐cause deaths or unplanned hospitalisations in heart failure (HF) at 18 months.Methods and results: OSICAT was a randomised, multicentre, open‐label French study in 937 patients hospitalised for acute HF ≤12 months before inclusion. Patients were randomised to telemonitoring (daily body weight measurement, daily recording of HF symptoms, and personalised education) (n = 482) or to SC (n = 455). Mean ± standard deviation number of events for the primary outcome was 1.30 ± 1.85 for telemonitoring and 1.46 ± 1.98 for SC [rate ratio 0.97, 95% confidence interval (CI) 0.77–1.23; P = 0.80]. In New York Heart Association (NYHA) class III or IV HF, median time to all‐cause death or first unplanned hospitalisation was 82 days in the telemonitoring group and 67 days in the SC group (P = 0.03). After adjustment for known predictive factors, telemonitoring was associated with a 21% relative risk reduction in first unplanned hospitalisation for HF [hazard ratio (HR) 0.79, 95% CI 0.62–0.99; P = 0.044); the relative risk reduction was 29% in patients with NYHA class III or IV HF (HR 0.71, 95% CI 0.53–0.95; P = 0.02), 38% in socially isolated patients (HR 0.62, 95% CI 0.39–0.98; P = 0.043), and 37% in patients who were ≥70% adherent to body weight measurement (HR 0.63, 95% CI 0.45–0.88; P = 0.006).Conclusion: Telemonitoring did not result in a significantly lower rate of all‐cause deaths or unplanned hospitalisations in HF patients. The pre‐specified subgroup results suggest the telemonitoring approach improves clinical outcomes in selected populations but need further confirmation.

ObjectivesThis study describes 5-year follow-up results of catheter ablation for atrial fibrillation (AF).BackgroundLong-term efficacy following catheter ablation of AF remains unknown.MethodsA total of 100 patients (86 men, 14 women), age 55.7 ± 9.6 years, referred to our center for a first AF ablation (63% paroxysmal; 3.5 ± 1.4 prior ineffective antiarrhythmic agents) were followed for 5 years. Complete success was defined as absence of any AF or atrial tachycardia recurrence (clinical or by 24-h Holter monitoring) lasting ≥30 s.ResultsArrhythmia-free survival rates after a single catheter ablation procedure were 40%, 37%, and 29% at 1, 2, and 5 years, respectively, with most recurrences over the first 6 months. Patients with long-standing persistent AF experienced a higher recurrence rate than those with paroxysmal or persistent forms (hazard ratio [HR]: 1.9, 95% confidence interval [CI]: 1.0 to 3.5; p = 0.0462). In all, 175 procedures were performed, with a median of 2 per patient. Arrhythmia-free survival following the last catheter ablation procedure was 87%, 81%, and 63% at 1, 2, and 5 years, respectively. Valvular heart disease (HR: 6.0, 95% CI: 2.0 to 17.6; p = 0.0012) and nonischemic dilated cardiomyopathy (HR: 34.0, 95% CI: 6.3 to 182.1; p < 0.0001) independently predicted recurrences. Major complications (cardiac tamponade requiring drainage) occurred in 3 patients (3%).ConclusionsIn selected patients with AF, a catheter ablation strategy with repeat intervention as necessary provides acceptable long-term relief. Although most recurrences transpire over the first 6 to 12 months, a slow but steady decline in arrhythmia-free survival is noted thereafter.