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Funding Acknowledgements Type of funding sources: None. Background/Introduction Smartwatch electrocardiograms (SW ECG) have been identified as a promising noninvasive solution to assess heart rhythm abnormalities, especially atrial arrhythmias (AA) which includes atrial fibrillation, atrial flutter and supraventricular tachycardia. This study evaluates the performance of the detection of AA with a smartwatch and compares the accuracy of two algorithms, the latest version of the original companion application (Apple ECG 2.0 App) and a novel deep neural network (DNN), in a population typical of an electrophysiology department. Purpose Determine if a novel DNN can improve the detection of AA on SW ECG in a tertiary care hospital. Methods 101 patients from the electrophysiology department of one tertiary center were included in this ongoing study. Three simultaneous ECGs were collected for each patient: one 12-lead ECG (Mindray BeneHeart R12) and two SW ECGs (Apple Watch) taken from the left wrist (SWw ECG) and the lower left abdomen (SWa ECG). 12-lead ECGs were adjudicated by a blinded expert electrophysiologist as 52 AA and 49 not AA and considered as gold standard. The SW ECGs were processed by the ECG 2.0 App and the DNN in parallel. The proportions of inconclusive diagnoses returned and the performances were assessed and compared. Results Overall, the ECG 2.0 App yielded inconclusive diagnoses for 19% (19/101) of all SWw ECGs while the DNN reduced that number to 0% (0/101). A similar result holds for SWa ECGs (Figure 1). Regarding the detection of AA from SWw ECGs, the ECG 2.0 App had a sensitivity of 81% (95% CI, 67%-90%), a specificity of 97% (95% CI, 87%-100%) and an accuracy of 89% (95% CI, 80%-94%) while the DNN had a sensitivity of 92% (95% CI, 82%-97%), a specificity of 90% (95% CI, 78%-96%) and an accuracy of 91% (95% CI, 84%-95%). For SWa ECGs (Figure 2), the sensitivity of the DNN was found significantly higher compared to the ECG 2.0 App: 96% (95% CI, 89%-98%) vs 76% (95% CI, 61%-87%). Conclusion(s): A novel DNN algorithm decreased the number of inconclusive diagnostics in the detection of AA from SW ECG from around 20% to 0%, which could help limit the overreading time spent by the physicians. Excluding inconclusive diagnostics, we observed no significant difference in performance between the two algorithms except for the sensitivity for SW ECG taken from the abdomen where the DNN outperforms the ECG 2.0 App. Routine application of this SW ECG analysis in tertiary care hospitals offers significant promise in arrhythmia diagnosis.

The implantation of pacemakers and defibrillators carries the highest risk of infection in interventional electrophysiology. The use of implantable cardiac devices is continually increasing with almost 2 million devices implanted worldwide each year. The recipients' profile may also be associated with an increased risk of infection. Several measures can be implemented to reduce the risk of device-related infection. Systematic antibiotic prophylaxis has proven to be beneficial provided that prescription modalities are respected, especially with respect to the selection of the appropriate molecule and timing of administration prior to the procedure. Despite all the precautions taken during surgery (asepsis, prophylactic antibiotic therapy….) the estimated rate of peri-procedural infection is around 2%. Device related infections are associated with a high rate of morbidity and mortality as well as substantial healthcare costs. Staphylococcus aureus (SA) and epidermidis (SE) are the pathogenic agents involved in most cases. Prevention is crucial given the difficulties in treating such infections because of the near-systematic need to remove the device and antibiotic resistance. Leadless pacemakers and subcutaneous defibrillators are potential alternatives to implantable endocardial devices, albeit with certain limitations. A group of experts has recently issued consensus paper on the prevention, diagnosis and treatment of infections associated with endocardial implantable cardiac devices.

Lors de la pandémie due au virus SARS-CoV2 les troubles du rythme n’ont pas été au premier plan. Cependant le virus semble atteindre de nombreux organes et le tropisme cardiaque est maintenant bien connu. Les connaissances dans ce domaine sont encore loin d’être exhaustives mais plusieurs séries publiées concernant les patients atteints de la COVID-19 retrouvent une proportion significative de troubles du rythme, dont certains pouvant potentiellement mener à une issue fatale. Ces troubles du rythmes sont principalement supra-ventriculaires à type de fibrillation atriale (FA) ou flutter mais également ventriculaire avec des tachycardies ventriculaires (TV) fibrillation ventriculaire (FV) et plus rarement torsades de pointe (TdP). Les causes en sont multiples du fait de l’atteinte multi-organe du virus et des interactions médicamenteuses potentielles. Par ailleurs la question de la surveillance de troubles du rythme pouvant émerger à moyen et long terme après une infection reste à explorer.

Funding Acknowledgements Type of funding sources: None. BACKGROUND Several studies have shown the excellent prognostic value of stress cardiovascular magnetic resonance (CMR). However, its prognostic value in patients with pacemaker (PM) remains unknown because most studies excluded PM patients. PURPOSE This study aimed to assess the prognostic value of vasodilator stress perfusion CMR in patients with PM. METHODS Consecutive patients with MR-conditional pacemakers referred for stress perfusion CMR at 1.5 T were followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular death or nonfatal myocardial infarction. Cox regressions analyses were performed to determine the prognostic value of CMR-parameters. The quality of CMR was rated by two observers blinded to clinical details. Data on pacemaker and leads were collected pre- and post-CMR. RESULTS Of 224 patients who completed the stress CMR protocol, 2 patients had inconclusive stress CMR due to artefact and 203 patients (72.9% male, mean age 71.4 ± 8.7 years) completed the follow-up (median [interquartile range], 7.0 [5.2-7.3] years). Among those, 23 experienced a MACE (11.3%). Stress CMR was well tolerated with no major adverse events. All scans were completed successfully with no significant change in lead thresholds or pacing parameters. Overall, the image quality was rated good or excellent in 84.1% of segments. Using Kaplan-Meier analysis, inducible ischemia and late gadolinium enhancement (LGE) were significantly associated with the occurrence of MACE (hazard ratio, HR: 11.80 [95% CI, 4.63-30.30]; and HR: 6.74 [95% CI, 2.47-18.40], both p CONCLUSION Stress CMR is safe, feasible and has a good discriminative prognostic value in consecutive patients with PM.

Resume Objectifs L’objectif principal etait d’estimer la proportion de non-adherence aux medicaments antihypertenseurs chez des patients avec hypertension en apparence resistante malgre un traitement optimal. L’objectif secondaire etait d’identifier les facteurs associes a une mauvaise adherence. Patients et methodes Etude monocentrique, observationnelle et prospective, ayant inclus des patients consecutifs suivis pour HTA resistante entre janvier 2014 et decembre 2017, ayant eu une mesure ambulatoire de la pression arterielle (MAPA) dans l’annee precedente et un bilan etiologique exhaustif durant les deux dernieres annees. L’hypertension etait consideree resistante si la MAPA de jour etait ≥ 135/85 mmHg et/ou la mesure des 24 heures ≥ 130/80 mmHg, malgre 4 medicaments antihypertenseurs a doses optimales. L’adherence au traitement a ete evaluee par l’echelle a 8 items de Morisky (MMAS-8). Resultats Nous avons recrute 386 patients, d’âge moyen de 64,6 ans, dont 48,2 % d’hommes. Les pressions arterielles de consultation, des 24 heures et de jour etaient en moyenne de 178,6/101,3 mmHg, 164,4/97,2 mmHg et 170,5/99,7 mmHg respectivement. Les proportions d’adherence faible, moyenne et elevee au traitement etaient de 24,5 %, 47,6 % et 27,9 % respectivement. Etaient associes a une mauvaise adherence le sexe feminin, le niveau d’instruction faible, le celibat, la polymedication et l’absence de pratique de l’automesure tensionnelle. Conclusion Plus de deux tiers des patients hypertendus apparemment resistants malgre un traitement optimal etaient partiellement ou completement non adherents au traitement dans notre etude. L’evaluation de l’adherence devrait etre systematique chez ces patients avant d’entreprendre des explorations complexes ou des therapies non pharmacologiques invasives.

The implantation of pacemakers and defibrillators carries the highest risk of infection in interventional electrophysiology. The use of implantable cardiac devices is continually increasing with almost 2 million devices implanted worldwide each year. The recipients' profile may also be associated with an increased risk of infection. Several measures can be implemented to reduce the risk of device-related infection. Systematic antibiotic prophylaxis has proven to be beneficial provided that prescription modalities are respected, especially with respect to the selection of the appropriate molecule and timing of administration prior to the procedure. Despite all the precautions taken during surgery (asepsis, prophylactic antibiotic therapy….) the estimated rate of peri-procedural infection is around 2%. Device related infections are associated with a high rate of morbidity and mortality as well as substantial healthcare costs. Staphylococcus aureus (SA) and epidermidis (SE) are the pathogenic agents involved in most cases. Prevention is crucial given the difficulties in treating such infections because of the near-systematic need to remove the device and antibiotic resistance. Leadless pacemakers and subcutaneous defibrillators are potential alternatives to implantable endocardial devices, albeit with certain limitations. A group of experts has recently issued consensus paper on the prevention, diagnosis and treatment of infections associated with endocardial implantable cardiac devices.

BACKGROUND Analysis of Holter recordings can be challenging and time-consuming, therefore requiring significant clinical resources in order to achieve a high-quality diagnosis. Such resources depend largely on the qualifications of the person conducting the analysis and the duration of the recordings. A novel Holter analysis platform has been developed, based on deep neural networks trained with a dataset of one million ECGs, to allow fast and reliable Holter recording analysis. PURPOSE This study sought to compare the performance of an artificial intelligence (AI)-based Holter analysis platform using deep learning tools with a classical one used on a daily basis in hospitals (the reference). The main endpoints evaluated were duration to complete the analysis by the physician operating it as well as diagnostic accuracy of each strategy, when platforms are used by electrophysiologists (EPs). METHODS For this prospective evaluation, a total of 159 Holter recordings (24-hour) were selected from a large Holter dataset from 1 hospital, with a relatively high prevalence of electrical rhythm and conduction disorders. Recordings were analysed by four EPs using independently both the AI-based and classical analysis platforms. All four EPs had no previous experience with the AI-based platform, except for an introductory 6-hour training session. Three EPs had multiple years of experience with the traditional platform, while one EP had limited experience. For each recording, in addition to the analysis duration, diagnostic accuracy was evaluated through the analysis of the presence or absence of predefined cardiac arrhythmias and conduction disorders (prevalence): pauses (25.2%), ventricular tachycardia (VT, 30.2%), atrial fibrillation (AF, 26.4%), high grade atrioventricular block (AVB, 10.1%) and burden of premature ventricular complex larger than 10% (PVC, 23.9%). Definite diagnostics were established by an expert EP after a careful examination of all available analysis reports. RESULTS Time required for the AI-based analysis was on average 42% shorter compared to the traditional platform (6.65 min vs 11.5 min, p < 0.0001). Regarding accuracy to detect electrical disorders, there was no statistically significant differences between AI-based and classical platforms (AF: 98.7% vs 96.9%, Pause: 99.4% vs 100%, PVC: 98.7% vs 98.7%, VT: 92.5% vs 96.2%, AVB: 98.7% vs 94.3%). CONCLUSION: These preliminary findings suggest that an AI-based strategy to analyse Holter recordings may be highly accurate in detecting cardiac electrical abnormalities, with significant time savings compared to a classical strategy, even for users with no previous experience with the novel AI-based platform. An AI-based Holter analysis platform may contribute to a broader and more resource-efficient adoption of Holter monitoring. Abstract Figure. analysis duration using each strategy

Resume Objectif Comparer une strategie therapeutique antihypertensive dite « acceleree » a une strategie « standard », en termes de taux de controle tensionnel et d’evenements indesirables. Patients et methodes Etude randomisee, menee en ouvert, ayant inclus des patients hypertendus consecutifs, nouvellement diagnostiques, âges entre 40 et 70 ans, n’ayant recu aucun traitement antihypertenseur anterieur. Le diagnostic d’hypertension arterielle etait retenu si la pression arterielle de consultation etait ≥ 140/90 mm Hg et confirmee par une automesure tensionnelle a domicile ou une mesure ambulatoire. Les patients etaient randomises selon un ratio 1/1 entre une strategie therapeutique « acceleree » et une strategie « standard ». Le critere primaire de l’etude etait le taux de controle tensionnel a 12 semaines. Le critere secondaire etait le taux d’evenements indesirables. Resultats Nous avons recrutes 268 patients (132 dans le groupe strategie acceleree), d’âge moyen de 55 ans, dont 62 % d’hommes. La pression arterielle de consultation etait en moyenne a l’entree dans l’etude de 168/95 mm Hg. Les caracteristiques cliniques de base etaient en moyenne identiques entre les deux groupes de traitement. A 12 semaines, les taux de controle tensionnel etaient de 63,6 % dans la strategie « acceleree » et de 38,2 % dans la strategie « usuelle » (p Conclusion La strategie antihypertensive acceleree etait plus efficace et aussi sure que la strategie usuelle dans notre etude ; ceci pourrait se traduire par une reduction des evenements cardiovasculaires futurs.

Purpose To evaluate the impact of an associated tricuspid annuloplasty on surgical mortality and morbidity in patients who underwent mitral valve replacement. Methods The study was prospective observational. We included all consecutive patients undergoing mitral valve replacement for severe mitral stenosis or regurgitation on native valve, between January 2016 and December 2018. Tricuspid annuloplasty was performed according to European guidelines, based on severity of tricuspid regurgitation and tricuspid annulus size (superior to 40 mm). The primary end point included in-hospital mortality, major bleeding, pericardial effusion, tamponade and pace maker implantation. Results Three hundred forty two patients were enrolled, with a mean age of 60.8 ± 15.7 years and 57.3% of men. Seventy three percent of patients were in class NYHA II/III, 19.6% in class IV and 7.4% in class I. Indication for mitral valve replacement was mitral regurgitation in 59.4% of cases. The mean left ventricular ejection fraction was 48.1 ± 10.3%. Associated tricuspid annuloplasty was performed in 61.7% (n = 211) of the patients. The rates of in-hospital mortality were respectively 6.3% and 14.8% in patients with and without associated tricuspid annuloplasty (P = 0.01). Major bleeding was more frequent in patients with associated tricuspid annuloplasty (8.5% vs. 17.3%; P = 0.02). The incidence of pericardial effusion, tamponade and pace maker implantation was similar between the 2 groups. Conclusion Our data show that associated tricuspid annuloplasty in patients undergoing mitral valve replacement did not increase surgical risk and in-hospital mortality, supporting a wider use of this technique in such patients.

Transcatheter aortic valve implantation (TAVI) is currently becoming the treatment of choice for patients with calcific aortic stenosis. Despite several technical improvements, the incidence of conduction disturbances has not diminished and remains TAVI's major complication. These disturbances include the occurrence of left bundle branch block and/or high-grade atrioventricular block often requiring pacemaker implantation. The proximity of the aortic valve to the conduction system (conduction pathways) accounts for the occurrence of these complications. Several factors have been identified as carrying a high risk of conduction disturbances like the presence of pre-existing right bundle branch block, the type of valve implanted, the volume of aortic and mitral calcifications, the size of the annulus and the depth of valve implantation. Left bundle branch block is the most frequent post TAVI conduction disturbance. Whereas the therapeutic strategy for persistent complete atrioventricular block is simple, it becomes complex in the presence of fluctuating changes in PR interval and left bundle branch block duration. The QRS width threshold value (150-160 ms) indicative of the need for pacemaker implantation is still being debated. Although there are currently no recommendations regarding the management of these conduction disturbances, the extension of TAVI indications to patient at low surgical risk calls for a standardization of our practice. However, a decision algorithm was recently proposed by a group of experts composed of interventional cardiologists, electrophysiologists and cardiac surgeons. There are still uncertainties about the appropriate timing of pacemaker implantation and the management of new onset left bundle branch block.

The primary objective was to estimate the proportion of non-adherence to antihypertensive drugs in patients with an apparently resistant hypertension despite optimal medical treatment. The secondary objective was to identify related factors to poor adherence.Monocentric, prospective and observational study, including consecutive patients, managed for an apparently resistant hypertension between January 2014 and December 2017, with an ambulatory blood pressure measurement (ABP) in the past year and a thorough etiological work up in the 2 past years. Hypertension was considered resistant if the daytime ABP was ≥ 135/85mmHg and/or the 24hours ABP≥to 130/80mmHg, despite 4 antihypertensive medications at optimal doses. Adherence to treatment was assessed by the eight-item Morisky Scale (MMAS-8).We enrolled 386 patients, with a mean age of 64.6 years, and 48.2% of men. The mean office blood pressure, 24hours and daytime APB were 178.6/101.3mmHg, 164.4/97.2mmHg and 170.5/99.7mmHg respectively. The proportions of low, medium and high adherence were 24.5%, 47.6% and 27.9% respectively. Associated-factors with poor adherence were female sex, low education level, celibacy, polypharmacy and lack of home self-blood pressure monitoring.Over two out of three patients with an apparently resistant hypertension under optimal treatment were partially or fully nonadherent to treatment in our study. Assessment of adherence would be systematic in these patients before implementing complex investigations or non-pharmacologic invasive procedures.

Purpose Evaluate the effect of early postoperative decline in right ventricular longitudinal function on mid term prognosis after aortic valve replacement for severe aortic stenosis. Methods The study was prospective observational, including all consecutive patients referred for severe aortic stenosis necessitating aortic valve replacement. Were excluded patients with decreased left ventricular ejection fraction ( Results 242 patients were included between 2013 January and 2017 December, with a mean age of 74 ± 11.6 years and 60.3% of men. Longitudinal right ventricular function was decreased in 143 patients (59.1%) at 2 weeks after surgery, with an incomplete but significant recovery 1 year after aortic valve replacement. After a median follow up of 2.9 ± 2.3 years, there wasn’t a significant association between early alteration of longitudinal right ventricular function and death or hospitalization for cardiac causes (P = 0.38 by log-rank test). Conclusions Early decrease in the parameters of longitudinal right ventricular function after aortic valve replacement for aortic stenosis doesn’t impact the mid term outcome.

Purpose Evaluate the effect of right ventricular pacing on the incidence of heart failure in patients implanted for symptomatic bradycardia. Methods The study was prospective and observational, including all consecutive patients implanted in our centre between 2014 January and 2017 December for symptomatic bradycardia. Heart failure diagnosis was based on clinical data, natriuretic peptides dosage and echocardiography. The follow up was done every 6 months. The cumulative heart failure rates were estimated using the Kaplan–Meier method, and variables associated with the risk of heart failure were identified by the Cox model. Results We included 736 patients, with a mean age of 76.6 ± 8.3 years, and 56.6% of men. Five hundred and three (68.3%) had a second or third atrio-ventricular block and the others a sinus node dysfunction. The proportions of NYHA class I, II, III and IV at inclusion were 28.6%, 49.7%, 17.4% and 4.3%, respectively. The mean left ventricular ejection fraction (LVEF) was 0.51 ± 0.10. After a median follow-up of 35.8 months, the cumulative rate of heart failure was 13.6% (CI 95%: 11.2%–16.0%). Predictive factors of heart failure occurrence were NYHA class (HR: 3.08; CI 95%: 2.45–4.41, for class II to IV versus class I); history of heart failure (HR: 2.10; CI 95%: 1.60–2.90); LVEF (HR: 2.13; CI 95%: 1.56–3.02, for LVEF ≤ 0.40 versus > 0.40); history of atrial fibrillation (HR: 1.48; CI 95%: 1.1–2.25); the percentage of ventricular pacing (HR: 3.26; CI 95%: 2.11–5.43; for %VP ≥ 90% versus Conclusions Right ventricular pacing is independently associated with the risk of heart failure. Using algorithms minimising unnecessary right ventricular pacing and cardiac resynchronisation therapy in some cases could reduce the incidence of the “pacing induced cardiomyopathy”.

Summary Purpose To determine if high-loop diuretics doses at discharge after acute heart failure are associated with higher two-years mortality. Methods The study was prospective observational. We enrolled all consecutive patients discharged after acute heart failure hospitalization between January 2013 and December 2016. The loop-diuretics used were furosemide and the doses were considered high if there were over 80 mg a day at discharge. The primary end point was 2 years total mortality. Patients were followed at our heart failure department and telephonic contact was established with the patients. Results In total, 1488 patients were included, wiyh a mean age of 74.3 ± 14.5 years and 51.9% of men. The etiology of heart failure was ischemic in 63.8% of cases. Furosemide was prescribed at highly doses for 42.6% of patients (n = 634; group 1). In a Cox model, high furosemide doses were significantly associated with an increase two years global mortality [HR: 2.56; CI 95% (1.72–3.68)]. Impaired left ventricular ejection fraction, anemia, chronic obstructive pulmonary disease, atrial fibrillation and renal dysfunction were other factors that impacted negatively the primary end point. Conclusion High -loop doses at discharge after hospitalization for acute heart failure are associated with an increased two-years mortality in chronic heart failure treated patients.

Objective:To estimate the proportion of nonadherence to antihypertensive drugs, using direct observation of therapy (DOT) in patients with apparent resistant hypertension.Design and method:The study was prospective and observational. We screened all consecutive patients managed in our outpatient hyp

Objective:To assess the correlation between “protocolized” and “non-protocolized” home blood pressure self-measurements in treated hypertensive patients.Design and method:The study was prospective and observational. We included consecutive outpatients managed in our center for hypertension, who cons

Background Right ventricular pacing (RVP) is the main treatment of symptomatic bradycardia. But it is well established that cardiac pacing induces electrical and mechanical left ventricular dyssynchrony. Purpose Evaluate the effect of RVP on the incidence of heart failure (HF) in patients implanted for symptomatic bradycardia. Methods The study was prospective, observational, including all consecutive patients implanted in our center between 2009 January and 2014 December for symptomatic bradycardia. HF diagnosis was based on clinical data, natriuretic peptides dosage and echocardiography. The follow up was done every 6 months. The cumulative HF rates were estimated using the Kaplan-Meier method, and variables associated with the risk of HF were identified by the Cox model. Results We included 986 patients, with a mean age of 74.6 ± 8.3 years, and 58.6% of men. A total of 675 (68.4%) had a second or third atrioventricular block and the others a sinus node dysfunction. The proportions of NYHA class I, II, III and IV at inclusion were 28.6%, 49.7%, 17.4% and 4.3% respectively. The mean left ventricular ejection fraction (LVEF) was 0.51 ± 0.10. After a median follow-up of 47.8 months, the cumulative rate of HF was 13.6% (CI 95%: 11.2%–16.0%). Predictive factors of HF occurrence were NYHA class (HR: 3.08; CI 95%: 2.45–4.41, for class II to IV versus class I); history of HF (HR: 2.10; CI 95%: 1.60–2.90); LVEF (HR: 2.13; CI 95%: 1.56–3.02, for LVEF ≤ 0.40 versus > 0.40); history of atrial fibrillation (HR: 1.48; CI 95%: 1.1–2.25); the percentage of ventricular pacing (HR: 3.26; CI 95%: 2.11–5.43; for %VP ≥ 90% versus Conclusions RVP is independently associated with the risk of HF. Using algorithms minimizing unnecessary RVP and cardiac resynchronization therapy in some cases could reduce the incidence of the “pacing induced cardiomyopathy”.

Resume Objectif. – Analyser les modalites du traitement preventif des recidives de fibrillation atriale (FA) paroxystique ou persistante par les antiarythmiques de la classe IC de Vaughan-Williams. Methodes. – Enquete observationnelle aupres de 326 cardiologues francais, comportant d'une part une enquete d'opinion, d'autre part un observatoire transversal de la pratique medicale. Chaque cardiologue devait inclure deux patients âges de moins de 65 ans ayant une FA non permanente (paroxystique ou persistante) sans dysfonction ventriculaire gauche (DVG) mis sous traitement par un antiarythmique de la classe IC apres retour en rythme sinusal. Resultats. – L'enquete d'opinion aupres des cardiologues indique que la FA non permanente represente 36,1 % des cas de FA, dont 57,8 % concernent des patients sans DVG. La plupart des cardiologues (85 %) declarent instaurer un traitement preventif des recidives chez 70–100 % de ces patients apres retour en rythme sinusal, par un antiarythmique de classe IC dans plus de 50 % des cas. Sur les 633 patients inclus dans l'observatoire, en majorite des hommes, 409 (64,6 %) avaient une FA paroxystique et 224 (35,4 %) une FA persistante. L'analyse de la prise en charge therapeutique indique que la modification du traitement anterieur et le choix d'un antiarythmique de classe IC se fondent principalement sur l'efficacite et sur la tolerance du traitement antiarythmique. Conclusion. – Les antiarythmiques de classe IC ont une place de choix pour le maintien en rythme sinusal des patients non âges ayant une FA non permanente sans DVG.

Aims To collect information on the use of the Reveal implantable loop recorder (ILR) in the patient care pathway and to investigate its effectiveness in the diagnosis of unexplained recurrent syncope in everyday clinical practice. Methods and results Prospective, multicentre, observational study conducted in 2006–2009 in 10 European countries and Israel. Eligible patients had recurrent unexplained syncope or pre-syncope. Subjects received a Reveal Plus, DX or XT. Follow up was until the first recurrence of a syncopal event leading to a diagnosis or for ≥1 year. In the course of the study, patients were evaluated by an average of three different specialists for management of their syncope and underwent a median of 13 tests (range 9–20). Significant physical trauma had been experienced in association with a syncopal episode by 36% of patients. Average follow-up time after ILR implant was 10 ± 6 months. Follow-up visit data were available for 570 subjects. The percentages of patients with recurrence of syncope were 19, 26, and 36% after 3, 6, and 12 months, respectively. Of 218 events within the study, ILR-guided diagnosis was obtained in 170 cases (78%), of which 128 (75%) were cardiac. Conclusion A large number of diagnostic tests were undertaken in patients with unexplained syncope without providing conclusive data. In contrast, the ILR revealed or contributed to establishing the mechanism of syncope in the vast majority of patients. The findings support the recommendation in current guidelines that an ILR should be implanted early rather than late in the evaluation of unexplained syncope.

Radiofrequency ablation is the reference treatment of refractory nodal reentry. Cryoablation has the advantage of having more modulable effects and minimises the risk of permanent atrioventricular block (AVB). Its immediate efficacy seems comparable to that of radiofrequency ablation but the long-term results are not well known. Endocavitary cryoablation of the slow pathway was undertaken in 26 patients (18 women) with an average age of 47.7 +/- 72.8 years with re-entrant nodal tachycardia refractory to medical therapy. The primary success rate was 92% (24 out of 26). On average, 2.6 +/- 2.2 (1 to 10) cryoablations at - 70 degrees C were delivered and were preceded by 6.4 +/- 4.5 (1 to 16) cryomappings to locate the site of the slow pathway. During cryomapping, 8 episodes of AVB were observed in 6 patients (6 second or third degree), all of which were revertible on rewarming. No cases of permanent AVB were observed. An oesophageal stimulation test of inducibility was performed on the 4th day in 21 patients, 16 of which were not reinducible. During follow-up of 355 +/- 194 days, 22 of the 26 patients (85%) had no recurrence of the arrhythmia. Two of the 24 primary successes had a recurrence, in addition to the two primary failures. Two of the four recurrences occurred in a non-sustained form which was less disabilitating for the patient and the recurrences were controlled in the 4 patients by antiarrhythmic therapy. These results suggest that cryoablation may be a reliable and effective long-term treatment of re-entrant nodal tachycardias. If confirmed in larger series in terms of efficacy and safety, cryoablation could become the treatment of choice of re-entrant nodal tachycardia.

Analyse the modalities of preventive therapy of recurrences of paroxysmal or persistent atrial fibrillation (AF) with Vaughan-Williams (VW) type IC antiarrhythmics.Observational study conducted with 326 French cardiologists established in general office practice, involving on the one hand an opinion survey among the cardiologists and on the other hand a cross-sectional observatory of usual medical practice. Each cardiologist was asked to include two patients aged less than 65 with non-permanent (paroxysmal or persistent) AF without left ventricle dysfunction (LVD) and initiated on treatment with a VW type IC antiarrhythmic after cardioversion to sinus rhythm.The opinion survey among the cardiologists indicates that non-permanent AF constitutes 36.1% of AF cases, of which 57.8% concern LVD-free patients. Most cardiologists (85%) declare to institute a preventive therapy of AF recurrences in 70-100% of these patients after cardioversion to sinus rhythm, with a VW type IC antiarrhythmic in more than 50% of cases. Of the 633 patients included in the FAUVE observatory, mainly men, 409 (64.6%) had paroxysmal AF and 224 (35.4%) had persistent AF. Analysis of therapeutic management shows that both alteration of the previous treatment and the choice of a VW type IC antiarrhythmic are based chiefly on efficacy and on tolerability of the antiarrhythmic therapy.VW type IC antiarrhythmics constitute a therapy of choice for the maintenance of sinus rhythm in non-aged and LVD-free patients with non-permanent AF.

was higher in the NRG (p 0.70 was the more accurate RT-MCE value to predict LV regional recovery with positive predictive value of 70% and negative predictive value of 56% (p

5551 Background: The standard treatment of locally advanced undifferentiated carcinoma of nasopharyngeal type (UCNT) is cisplatin based chemotherapy followed by locoregional radiotherapy. The purpo...

Results: Baseline (unpaced) interVA and LVdPdhmx did not differ signficandy before and after the S-week BiV pacing period (-30&71x and -30&8ms and 1867~456mmHgis and 1964&316mmHg/s, respectively). Maximal increase in LVdPdhmx was similar during acute LV and BiV pacing (10.5&4.8% and 12.0&7.3%, respectively). The chronic maximal increase in LVdPdhmx (17.0&5.5% and 17.5&6.7%, respectively) was higher than the acute response in all but one animal, in which acute and chronic response was similar. Acute and chronic maximal response occurred at the same interVA (-15&91x and -15&611x, respectively, both significantly different from baseline). The interVALVdPdhmx response curve was identical for LV and BiV pacing. Comparison of the acute and chronic LVdPdhmx at identical interVA values by linear regression showed that the shape of the acute and chronic response curves did not differ (r=0.91) but that the amplitude of the response increased over the entire range of interVA (slope=2.0&1.3).