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Funding Acknowledgements Type of funding sources: None. Objective. Risk-benefit assessment for cardiac resynchronization therapy defibrillator (CRT-D) over a CRT pacemaker (CRT-P) is still a matter of debate. We aimed to identify patients with a bad outcome within one year after CRT-D implantation, and to develop a Futile CRT-D score. Methods. Based on the administrative hospital-discharge database, all consecutive patients treated with CRT-D implantation in France between 2010 and 2019 were included. A prediction model was derived and validated for one-year all-cause death after CRT-D implantation (considered as futility) by using split-sample validation. Results. 28,503 patients were included in the analysis (mean age 68 ± 10 years); 2,139 (7.5%) deaths were recorded in the first year. In the derivation cohort (n = 14,252), the final logistic regression model included as main predictors of futility older age, diabetes, mitral regurgitation, history of hospital stay with heart failure, history of pulmonary oedema, atrial fibrillation, renal, pulmonary, liver, or thyroid disease, denutrition and anemia. Based on Futile CRT-D score, 17% of these patients were categorized at high risk (Futile CRT-D score ≥13) and predicted futility at 17%. Conclusion. The futility CRT-D score, established from a large nationwide cohort of patients treated with CRT-D may provide a relevant tool for optimizing healthcare decision. Death at one year in patients with CRTD OR (95%CI)pPointsAge (quartile)1.353 (1.266-1.446)61, 2 points when age >69, 3 points when age >75.Abstract Figure. AUC and incidences of all-causes death

Background QTc interval monitoring, for the prevention of drug-induced arrhythmias is necessary, especially in the context of coronavirus disease 2019 (COVID-19). For the provision of widespread use, surrogates for 12‑lead ECG QTc assessment may be useful. This prospective observational study compared QTc duration assessed by artificial intelligence (AI-QTc) (Cardiologs®, Paris, France) on smartwatch single‑lead electrocardiograms (SW-ECGs) with those measured on 12‑lead ECGs, in patients with early stage COVID-19 treated with a hydroxychloroquine−azithromycin regimen. Methods Consecutive patients with COVID-19 who needed hydroxychloroquine−azithromycin therapy, received a smartwatch (Withings Move ECG®, Withings, France). At baseline, day-6 and day-10, a 12‑lead ECG was recorded, and a SW-ECG was transmitted thereafter. Throughout the drug regimen, a SW-ECG was transmitted every morning at rest. Agreement between manual QTc measurement on a 12‑lead ECG and AI-QTc on the corresponding SW-ECG was assessed by the Bland-Altman method. Results 85 patients (30 men, mean age 38.3 ± 12.2 years) were included in the study. Fair agreement between manual and AI-QTc values was observed, particularly at day-10, where the delay between the 12‑lead ECG and the SW-ECG was the shortest (−2.6 ± 64.7 min): 407 ± 26 ms on the 12‑lead ECG vs 407 ± 22 ms on SW-ECG, bias −1 ms, limits of agreement −46 ms to +45 ms; the difference between the two measures was, Highlights • Artificial intelligence fairly interpreted QTc • Single lead smartwatch ECG is an option for home monitoring ECG • Because of social distancing necessity with COVID-19, home monitoring ECG is crucial.

Background The previous studies have shown that a systematic assessment, during the initial hospitalization after sudden cardiac death (SCD), provides the capacity to unmask specific etiology. The diagnosis of idiopathic ventricular fibrillation (IVF) is probably overestimated because of an unsystematic workup. Purpose We aimed to assess the profitability of comprehensive medical investigation strategy after SCD in a single university center. Methods Based on an implantable cardiac defibrillator data-base interrogation, the patients who survived from ventricular fibrillation without reversible cause were identified between 2012 and 2019. The etiological examinations performed during the initial hospitalization or planned after discharge were collected. Results In a cohort of 66 patients, retrospectively included, a minimal assessment including twelve-lead ECG, trans-thoracic echocardiography and coronary imaging allowed to unmask etiology for 40 (61%) patients. Ventricular fibrillation remained idiopathic for 16(24%) patients by adding magnetic resonance imaging, and for 12(18%) patients by performing provocative and genetic tests. Among the 54 patients for whom the diagnosis was confirmed, we reported 12(22%) electrical cardiac disorders, 11(20%) ischemic cardiopathy, 9(17%) dilated cardiomyopathy, 9(17%) valvular disease, 8(15%) hypertrophic cardiomyopathy, 4(7%) myocarditis and 1(2%) tako-tsubo syndrome. The number of examinations carried out in the IVF cohort did not differ from the others (6 vs. 5, P = 0.06). In the IVF group, SCD event occurred more frequently at rest (8/12 vs. 14/54, P = 0.02) and the patients were preferably women (9/12 vs. 13/54, P = 0.02). Conclusion Systematic etiologic investigations, carried out during initial assessment after SCD, allowed to unmask etiology for a large number of patients. Further studies are needed to standardize the workup to implement in all tertiary centers.

Background Early repolarization pattern (ERP) is a common ECG aspect in general population. However, it is also associated with sudden cardiac death (SCD). ERP consensus definition has been recently published in 2015. While syncope is a common occur, ERP prevalence using new diagnostic criteria n this population remains unknown. Purpose We sought to determine prevalence of ERP in patient referred to syncope unit. Method We retrospectively analyzed the baseline 12-lead ECG of 150 patients without structural heart disease eferred to syncope unit for confirmed syncope between January 2017 and December 2018. After complete evaluation, yncope were classified as reflex, hypotensive, cardiac or unexplained. RP was defined as he presence of an end-QRS slur or notch with Jp elevation ≥ 0.1 mV, in ≥ 2 contiguous leads, excluding V1 to V3 nd QRS duration Results ERP was identified in 19 (12.7%) patients. A slurring was observed in 8 (42.1%) patients, a notch in 7 (36.8%) and 4 (21.1%) had both notching and slurring. p elevation was 1.63 ± 0.68 mm, with 9 (47.4%) patients presenting Jp elevation ≥ 0.2 mV. ERP was localized in inferior (n = 11(57.9%)), lateral (n = 3(15.8%)) or in both inferior and lateral leads (n = 5(26.3%)). It was associated with an ascendant ST-segment in 16 (84.2%) patients. Male and unexplained syncope were significantly more represented in patient with ERP, respectively 15 (79%) vs.62 (47.3%) (P = 0.01) and 8 (42.1%) vs.19 (14.5%) (P = 0.003). There was no difference between the two groups in term of age, number of syncope, family history of SCD, duration of syncopal history and injuries concomitant with syncope. Conclusion ERP was present in 12.7% of patients referred to syncope unit for confirmed syncope. There was a higher rate of unexplained syncope and men in this group. Further studies are needed to determine prognosis of ERP in this population.

We studied the clinical and radiological features of pulmonary metastases present in 4 out of 22 patients with medullary carcinoma of thyroid. Two patients presented with common metastases: macronodules in one, and micronodules in the other one. The other two patients presented initially with reticulonodular perihilar lesions on chest X-ray, leading to the diagnosis of sarcoidosis in both of them. The observation of such pulmonary metastases is original: initially latent, they progress very slowly, and they correspond to a lymphangitic spread of the tumour with amyloid deposition in peribronchovascular structures without alveolar involvement, as shown in one of our cases with pathologic study.