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Aims Handheld electrocardiogram (ECG) monitors are increasingly used by both healthcare workers and patients to diagnose cardiac arrhythmias. There is a lack of studies validating the use of handheld devices against the standard 12-lead ECG. The Kardia 6L is a novel handheld ECG monitor which can produce a 6-lead ECG. In this study, we compare the 6L ECG against the 12-lead ECG. Methods and results A prospective study consisting of unselected cardiac inpatients and outpatients at Leeds Teaching Hospital NHS Trust. All participants had a 12- and 6-lead ECGs. All ECG parameters were analysed by using a standard method template for consistency between independent observers. Electrocardiograms from the recorders were compared by the following statistical methods: linear regression, Bland–Altman, receiver operator curve, and kappa analysis. There were 1015 patients recruited. The mean differences between recorders were small for PR, QRS, cardiac axis, with receiver operator analysis area under the curve (AUC) of >80%. Mean differences for QT and QTc (between recorders) were also small, with AUCs for QT leads of >75% and AUCs for QTc leads of >60%. Key findings from Bland–Altman analysis demonstrate overall an acceptable agreement with few outliers instances ( Conclusion Several parameters recorded by the Kardia 6L (QT interval in all six leads, rhythm detection, PR interval, QRS duration, and cardiac axis) perform closely to the gold standard 12-lead ECG. However, that consistency weakens for left ventricular hypertrophy, QRS amplitudes (Lead I and AVL), and ischaemic changes.

The field of pacing in Africa has evolved in an uncoordinated way across the continent with significant variation in local expertise, cost, and utilization. There are many countries where pacemaker services do not meet one-hundredth of the national demand. Regional, national, and institutional standards for pacemaker qualification and credentials are lacking. This paper reviews the current needs for bradycardia pacing and evaluates what standards should be set to develop pacemaker services in a resource-constrained continent, including the challenges and opportunities of capacity building and training as well as standards for training programs (training prerequisites, case volumes, program content, and evaluation).

BackgroundThe incidence of sports-related sudden cardiac arrest (SrSCA) in sub-Saharan Africa is unknown.ObjectiveTo determine the incidence of sudden cardiac arrest (SCA) in non-competitive athletes in an urban population of Cameroon, a country in sub-Saharan Africa.MethodsTwo study populations in Cameroon were used. A 12-month, multisource surveillance system of 86 189 inhabitants over 12 years old recorded all deaths in two administrative districts of Douala City. All fields of sports, emergency medical service, local medical examiners and district hospital mortuaries were surveyed. Two blinded cardiologists used a verbal autopsy protocol to determine the cause of death. SCA was identified for all deaths occurring within 1 hour of onset of symptoms. A cross-sectional study was conducted among 793 persons in Yaoundé City, which is the second study population aimed at determining the proportion of people who are physically active.ResultsThe mean age in the cross-sectional study was 27.3±10.7, with more men (56.2%). The cross-sectional study showed that 69.0% (95% CI 65.8 to 72.2) of the population could be considered to have at least 3 hours of physical activity per week. The surveillance found that among 288 all-cause deaths, 27 (9.4%) were due to SCA. One SrSCA was registered in a 35-year-old woman while running. Merging both sources revealed an SrSCA incidence of 1.7 (95% CI 0.2 to 12.0) cases per 100 000 athletes per year.ConclusionThis pioneer study reports the incidence estimates of SrSCA in a sub-Saharan African general population and should be regarded as a first step to a big problem.

The field of pacing in Africa has evolved in an uncoordinated way across the continent with significant variation in local expertise, cost, and utilization. There are many countries where pacemaker services do not meet one-hundredth of the national demand. Regional, national, and institutional standards for pacemaker qualification and credentials are lacking. This paper reviews the current needs for bradycardia pacing and evaluates what standards should be set to develop pacemaker services in a resource-constrained continent, including the challenges and opportunities of capacity building and training as well as standards for training programs (training prerequisites, case volumes, program content, and evaluation).

Screen-based media overuse has been related to harmful consequences especially among children and adolescents. Given their complex interrelationships, predictors of screen time (ST) should be analyzed simultaneously rather than individually to avoid incomplete conclusions.Structural equation models were conducted to examine associations between media ST (television, video games, and computers) along with harmful consequences in adolescents' well-being, such as underweight and overweight, depression, and school failure. Predictors included individual (gender, age, and physical activity), family (structure and socioeconomic background), and substance use variables. We used the Health Behaviour in School-aged Children survey organized in 2014, including eighth- and ninth-grade students living in France (N = 3720).Students reported spending 3 hours per day in front of each media. Spending more than 2 hours behind each of those 3 media was associated with lower life satisfaction, less physical activity, active school bullying, and grade repetition. Socioeconomic status was the most important predictor of ST, whereas regular substance uses showed modest associations.The main implication of our findings is to sensitize parents and stakeholders about the limitation of ST, including their own use that adolescents are likely to mimic. Alternative measures such as off-line time should be encouraged.

Background Incidence estimates of sudden cardiac death (SCD) in sub-Saharan Africa (SSA) are unknown. Method Over 12 months, the household administrative office and health community committee within neighbourhoods in two health areas of Douala, Cameroon, registered all deaths among 86 188 inhabitants aged >18 years. As part of an extended multi-source surveillance system, the Emergency Medical Service (EMS), local medical examiners and district hospital mortuaries were also surveyed. Whereas two physicians investigated every natural death, two cardiologists reviewed all unexpected natural deaths. Results There were 288 all-cause deaths and 27 (9.4%) were SCD. The crude incidence rate was 31.3 [95% confidence interval (CI): 20.3–40.6]/100 000 person-years. The age-standardized rate by the African standard population was 33.6 (95% CI: 22.4–44.9)/100 000 person-years. Death occurred at night in 37% of cases, including 11% of patients who died while asleep. Out-of-hospital sudden cardiac arrest occurred in 63% of cases, 55.5% of which occurred at home. Of the 88.9% cases of witnessed cardiac arrest, 63% occurred in the presence of a family member and cardiopulmonary resuscitation was attempted only in 3.7%. Conclusion The burden of SCD in this African population is heavy with distinct characteristics, whereas awareness of SCD and prompt resuscitation efforts appear suboptimal. Larger epidemiological studies are required in SSA in order to implement preventive measures, especially in women and young people.

Major structural cardiovascular diseases are associated with cardiac arrhythmias, but their full spectrum remains unknown in sub-Saharan Africa (SSA), which we addressed in this systematic review. Atrial fibrillation/atrial flutter (AF/AFL) prevalence is 16–22% in heart failure, 10–28% in rheumatic heart disease, 3–7% in cardiology admissions, but

Aims Cardiac arrhythmia services are a neglected field of cardiology in Africa. To provide comprehensive contemporary information on the access and use of cardiac arrhythmia services in Africa. Methods and results Data on human resources, drug availability, cardiac implantable electronic devices (CIED), and ablation procedures were sought from member countries of Pan African Society of Cardiology. Data were received from 23 out of 31 countries. In most countries, healthcare services are primarily supported by household incomes. Vitamin K antagonists (VKAs), digoxin, and amiodarone were available in all countries, while the availability of other drugs varied widely. Non-VKA oral anticoagulants (NOACs) were unequally present in the African markets, while International Normalized Ratio monitoring was challenging. Four countries (18%) did not provide pacemaker implantations while, where available, the implantation and operator rates were 2.79 and 0.772 per million population, respectively. The countries with the highest pacemaker implantation rate/million population in descending order were Tunisia, Mauritius, South Africa, Algeria, and Morocco. Implantable cardioverter-defibrillator and cardiac resynchronization therapy (CRT) were performed in 15 (65%) and 12 (52%) countries, respectively. Reconditioned CIED were used in 5 (22%) countries. Electrophysiology was performed in 8 (35%) countries, but complex ablations only in countries from the Maghreb and South Africa. Marked variation in costs of CIED that severely mismatched the gross domestic product per capita was observed in Africa. From the first report, three countries have started performing simple ablations. Conclusion The access to arrhythmia treatments varied widely in Africa where hundreds of millions of people remain at risk of dying from heart block. Increased economic and human resources as well as infrastructures are the critical targets for improving arrhythmia services in Africa.

Background Inappropriate implantable cardioverter-defibrillator (ICD) shocks is a common complication in Brugada syndrome. However, the incidence in recipients of ICD for primary and secondary prevention is unknown. Method and results We compared the rate of inappropriate shocks in patients with Brugada syndrome that had an ICD for primary and secondary prevention. We studied 51 patients, 86.5% of whom were males. Their mean age at diagnosis was 47 ± 11 years. Eighteen (35%) were asymptomatic, while 25 (49%) experienced syncope prior to implantation. Eight (16%) patients were resuscitated from ventricular fibrillation before implantation. During a mean follow-up of 78 ± 46 months, none of the asymptomatic patients experienced appropriate therapy, whereas 21.6% of symptomatic patients had ≥1 shock. Inappropriate shock occurred in 7 (13.7%) patients, with a mean IS of 6.57 ± 6.94 shocks per patient occurring 16.14 ± 10.38 months after implantation. There was a trend towards higher incidence of inappropriate shock in the asymptomatic group (p = 0.09). The interval from implantation to inappropriate shock occurrence was 13.91 ± 12.98 months. The risk of IS at 3 years was 13.7%, which eventually plateaued over the time. Conclusion Inappropriate shock is common in Brugada syndrome during the early periods after an ICD implantation, and seems to be more likely in asymptomatic patients. This finding may warrant a review of the indications for ICD implantation, especially in the young and apparently healthy population of patients with Brugada syndrome.

Cette contribution vise a mieux quantifier le temps que les collegiens passent devant les divers types d'ecrans (smartphone, ordinateur, tablette et console de jeux) et a interroger d'eventuelles associations entre la duree d'exposition et certaines pratiques du comportement.

International audience; Background - Introduction to alcohol consumption early in life increases the risk of alcohol dependency and hence motivational interventions are needed in young patients visiting the emergency department (ED). Aim - This study aims to investigate the efficacy of a brief motivational intervention in reducing alcohol consumption among young ED patients. Patients and methods - This was a blind randomized controlled trial with follow-up at 3 months. Patients were stratified on the basis of age and blood alcohol level of 0.5 g/l or more. A total of 263 patients aged 16-24 were randomized, with 132 patients in the brief motivational intervention group and 131 in the control group, with data collection at 3 months. From September 2011 to July 2012, a psychologist performed the brief motivational intervention 5 days after the patients' discharge. A phone call was made at 1 and 2 months. The control group received a self-assessment leaflet. The reduction in consumption was determined on the basis of the number of drinks consumed in the last week prior to the survey. Results - The mean reduction between number of drinks at baseline and number of drinks at 3 months in the control group was 0.3 and that in the intervention group was 0.9. This reduction in alcohol use in the brief motivational intervention group was not significant. The study did not show an association between brief motivational intervention and repeated drunkenness [relative risk (RR): 0.99, 95% confidence interval (CI): 0.79-1.24], alcohol consumption at least once a month (RR: 0.81, 95% CI: 0.31-2.10) and alcohol consumption at least 10 times during the month (RR: 1.1, 95% CI: 0.96-1.26). Conclusion - We did not observe a significant decrease in alcohol consumption among the youth. Further studies are needed to confirm the positive impact of a brief motivational intervention in the ED.

Africa is experiencing an increasing burden of cardiac arrhythmias. Unfortunately, the expanding need for appropriate care remains largely unmet because of inadequate funding, shortage of essential medical expertise, and the high cost of diagnostic equipment and treatment modalities. Thus, patients receive suboptimal care. A total of 5 of 34 countries (15%) in Sub-Saharan Africa (SSA) lack a single trained cardiologist to provide basic cardiac care. One-third of the SSA countries do not have a single pacemaker center, and more than one-half do not have a coronary catheterization laboratory. Only South Africa and several North African countries provide complete services for cardiac arrhythmias, leaving more than hundreds of millions of people in SSA without access to arrhythmia care considered standard in other parts of the world. Key strategies to improve arrhythmia care in Africa include greater government health care funding, increased emphasis on personnel training through fellowship programs, and greater focus on preventive care.

Chronic non-specific respiratory symptoms are difficult to manage. This trial aimed to evaluate the association between baseline fractional exhaled nitric oxide (FeNO) and the response to inhaled corticosteroids in patients with non-specific respiratory symptoms.In this double-blind randomised placebo-controlled trial, we enrolled undiagnosed patients, aged 18-80 years, with cough, wheeze, or dyspnoea and less than 20% bronchodilator reversibility across 26 primary care centres and hospitals in the UK and Singapore. Patients were assessed for 2 weeks before being randomly assigned (1:1) to 4 weeks of treatment with extrafine inhaled corticosteroids (QVAR 80 μg, two puffs twice per day, equivalent to 800 μg per day beclomethasone dipropionate) or placebo. Randomisation was stratified by baseline FeNO measurement: normal (≤25 parts per billion [ppb]), intermediate (25 tp40 ppb), and high (≥40 ppb). The primary endpoint was change in Asthma Control Questionnaire (ACQ7) mean score. We used generalised linear modelling to assess FeNO as a predictor of response, estimating an interaction effect between FeNO and treatment on change in ACQ7. We did our primary and secondary analyses in the per-protocol set, which excluded patients with non-completion of the primary endpoint, non-compliance to treatment (ascertained by patient report), and study visits made outside the predefined visit windows. This study is registered on ClinicalTrials.gov, number NCT02294279.Between Feb 4, 2015, and July 12, 2016, we randomly assigned 294 patients to extrafine inhaled corticosteroid treatment (n=148) or placebo (n=146). Following exclusions due to protocol violations, we analysed 214 patients (114 extrafine inhaled corticosteroids and 100 placebo). We observed a significant interaction between baseline FeNO and treatment group for every 10 ppb increase in baseline FeNO, with the change in ACQ7 greater in the extrafine inhaled corticosteroids group than in the placebo group (difference between groups 0·071, 95% CI 0·002 to 0·139; p=0·044). The most common adverse events were nasopharyngitis (18 [12%] patients in the treatment group vs 13 [9%] in the placebo group), infections and infestations (25 [17%] vs 21 [14%]), and respiratory, thoracic, and mediastinal disorders (13 [9%] vs 17 [12%]).FeNO measurement is an easy and non-invasive tool to use in clinical practice in patients with non-specific respiratory symptoms to predict response to inhaled corticosteroids. Further research is needed to examine its role in patients with evidence of other airway diseases, such as chronic obstructive pulmonary disease.Sponsored by OPRI with partial funding by Circassia and study drugs provided by TEVA.

Aims To provide comprehensive information on the access and use of cardiac implantable electronic devices (CIED) and catheter ablation procedures in Africa. Methods and results The Pan-African Society of Cardiology (PASCAR) collected data on invasive management of cardiac arrhythmias from 2011 to 2016 from 31 African countries. A specific template was completed by physicians, and additional information obtained from industry. Information on health care systems, demographics, economics, procedure rates, and specific training programs was collected. Considerable heterogeneity in the access to arrhythmia care was observed across Africa. Eight of the 31 countries surveyed (26%) did not perform pacemaker implantations. The median pacemaker implantation rate was 2.66 per million population per country (range: 0.14–233 per million population). Implantable cardioverter-defibrillator and cardiac resynchronization therapy were performed in 12/31 (39%) and 15/31 (48%) countries respectively, mostly by visiting teams. Electrophysiological studies, including complex catheter ablations were performed in all countries from Maghreb, but only one sub-Saharan African country (South Africa). Marked variation in cost (up to 1000-fold) was observed across countries with an inverse correlation between implant rates and the procedure fees standardized to the gross domestic product per capita. Lack of economic resources and facilities, high cost of procedures, deficiency of trained physicians, and non-existent fellowship programs were the main drivers of under-utilization of interventional cardiac arrhythmia care. Conclusion There is limited access to CIED and ablation procedures in Africa. A quarter of countries did not have pacemaker implantation services, and catheter ablations were only available in one country in sub-Saharan Africa.

Background Results of associations between process and mortality indicators, both used for the external assessment of hospital care quality or public reporting, differ strongly across studies. However, most of those studies were conducted in North America or United Kingdom. Providing new evidence based on French data could fuel the international debate on quality of care indicators and help inform French policy-makers. The objective of our study was to explore whether optimal care delivery in French hospitals as assessed by their Hospital Process Indicators (HPIs) is associated with low Hospital Standardized Mortality Ratios (HSMRs). Methods The French National Authority for Health (HAS) routinely collects for each hospital located in France, a set of mandatory HPIs. Five HPIs were selected among the process indicators collected by the HAS in 2009. They were measured using random samples of 60 to 80 medical records from inpatients admitted between January 1st, 2009 and December 31, 2009 in respect with some selection criteria. HSMRs were estimated at 30, 60 and 90 days post-admission (dpa) using administrative health data extracted from the national health insurance information system (SNIIR-AM) which covers 77% of the French population. Associations between HPIs and HSMRs were assessed by Poisson regression models corrected for measurement errors with a simulation-extrapolation (SIMEX) method. Results Most associations studied were not statistically significant. Only two process indicators were found associated with HSMRs. Completeness and quality of anesthetic records was negatively associated with 30 dpa HSMR (0.72 [0.52–0.99]). Early detection of nutritional disorders was negatively associated with all HSMRs: 30 dpa HSMR (0.71 [0.54–0.95]), 60 dpa HSMR (0.51 [0.39–0.67]) and 90 dpa HSMR (0.52 [0.40–0.68]). Conclusion In absence of gold standard of quality of care measurement, the limited number of associations suggested to drive in-depth improvements in order to better determine associations between process and mortality indicators. A smart utilization of both process and outcomes indicators is mandatory to capture aspects of the hospital quality of care complexity. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2534-3) contains supplementary material, which is available to authorized users.

Background : The estimated rate of sudden cardiac death (SCD) in Western countries ranges from 300 000 to 400 000 annually, which represents 0.36 to 1.28 per 1 000 inhabitants in Europe and the United States. The burden of SCD in Africa is unknown. Our aim is to assess the epidemiology of SCD in Africa. Methods : The Pan-Africa SCD study is a prospective, multicentre, community-based registry monitoring all cases of cardiac arrest occurring in victims over 15 years old. We will use the definition of SCD as 'witnessed natural death occurring within one hour of the onset of symptoms' or 'unwitnessed natural death within 24 hours of the onset of symptoms'. After approval from institutional boards, we will record demographic, clinical, electrocardiographic and biological variables of SCD victims (including survivors of cardiac arrest) in several African cities. All deaths occurring in residents of districts of interest will be checked for past medical history, circumstances of death, and autopsy report (if possible). We will also analyse the employment of resuscitation attempts during the time frame of sudden cardiac arrest (SCA) in various patient populations throughout African countries. Conclusion : This study will provide comprehensive, contemporary data on the epidemiology of SCD in Africa and will help in the development of strategies to prevent and manage cardiac arrest in this region of the world.

SummaryBackgroundThe burden of sudden unexplained death in sub-Saharan Africa is unknown.AimThe aim of this study is to establish the epidemiology of sudden cardiac death in Cameroon.MethodsThe Douala sudden unexplained death (Douala-SUD) study is a prospective, multiple-source, community-based surveillance of all cases of unexpected death (15 years. After approval from institutional boards, all deaths occurring in residents of four areas of Douala city will be checked for circumstances of death and past medical history. Subjects who die naturally will be further investigated. Unexpected death victims will be checked for detailed demographic, clinical, electrocardiographic, echocardiographic and biological records. Autopsy background and genetic analysis (postmortem or in first relatives if the young victim is aged

Background There is limited information on managing cardiac arrhythmias in Africa. Methods The pan-African Society of Cardiology (PASCAR) conducted from 2011 to 2017 several surveys on cardiac arrhythmia services across African countries. The questionnaire filled in by cardiologists focused on availability of human resources, diagnostic tools and treatment modalities in each country. Additional information came from manufacturers. Results We received responses from 33 out of 55 (60%) African countries. Limited use of basic cardiovascular drugs such as antiarrhythmics and anticoagulants prevails. Non-vitamin K dependent oral anticoagulants (NOACs) are not widely used on the continent, even in North Africa. Six (18%) of sub-Saharan African (SSA) countries do not provide basic cardiac work-up and about one-third do not have pacemaker services. The median pacemaker implantation rate was 2.66 per million population per country, which is 200-fold lower than in Europe. The density of pacemaker facilities and operators in Africa is quite low with a median of 0.14 [0.03–6.36] center and 0.10 [0.05–9.49] operator per million population. Only South Africa providing the full complement of services for cardiac arrhythmia in SSA. Overall, countries in North Africa have better coverage, leaving more than 110 million people in SSA without access to effective basic arrhythmia treatments. Conclusion The lack of human expertise, diagnostic and treatment services for cardiac arrhythmias is a common scenario in the vast majority of SSA countries, resulting in suboptimal care and subsequent high burden of premature cardiac death. There is a need to improve the standard of arrhythmia care by providing essential services such as rhythm monitoring, access to anticoagulation and to essential antiarrhythmic drugs, and cardiac pacemaker implantations.

BACKGROUND In-hospital mortality is widely used to judge the quality of hospital care, but is biased by discharge patterns. Fixed-timeframe indicators have thus been recommended. However, the 30-day postadmission indicator may underestimate hospital-wide mortality, as patients dying in hospital >30 days after admission are considered as survivors. OBJECTIVES To identify the most relevant timeframes and to assess the contribution of cause-of-death data. METHODS The 2009 French hospital discharge database was linked to vital status records and to the causes of death register for 11.5 million hospital stays by beneficiaries of French general health insurance. Correlations and agreements between the 30-day hospital standardized mortality ratio (HSMR) and the in-hospital, 60-, 90-, 180-, and 365-day postadmission HSMRs were estimated. RESULTS A total of 7.8%, 1.5%, and 0.5% of patients who died during their hospital stay were considered as survivors by the 30-, 60-, and 90-day HSMRs, respectively. The 30-day HSMR correlated strongly with the 60-day HSMR (Pearson coefficient=0.92), and their agreement on outlier status was excellent (κ coefficient=0.80). The association remained substantial at 90 days, but weakened at 180 days and even more so at 365 days. Regardless of the timeframe, exclusion of deaths likely due to independent causes barely modified the indicators. CONCLUSIONS This nationwide study shows that 60- and 90-day HSMRs encompass in-hospital deaths better than the 30-day HSMR, while capturing the same interhospital variations. They should thus be preferred. The contribution of cause-of-death data to hospital-wide indicators seems negligible.

Background Effects of antiretroviral therapy (ART) on birth outcomes remain controversial. Objective To assess the impact of antenatal exposure to ART on the occurrence of preterm birth (PTB) and low birth weight (LBW). Methods A cross-sectional study conducted at the Essos Hospital Center in Yaounde from 2008 to 2011 among HIV vertically exposed infants with two distinct maternal antiretroviral experiences: monotherapy group (Zidovudine, ZDV) and the combination ART group (cART). Mothers already receiving cART before pregnancy were ineligible. In both groups, events of PTB (

Summary Background The estimated rate of sudden cardiac death (SCD) in Western countries ranges from 300 000 to 400 000 annually, which represents 0.36 to 1.28 per 1 000 inhabitants in Europe and the United States. The burden of SCD in Africa is unknown. Our aim is to assess the epidemiology of SCD in Africa. Methods The Pan-Africa SCD study is a prospective, multicentre, community-based registry monitoring all cases of cardiac arrest occurring in victims over 15 years old. We will use the definition of SCD as ‘witnessed natural death occurring within one hour of the onset of symptoms’ or ‘unwitnessed natural death within 24 hours of the onset of symptoms’. After appro val from institutional boards, we will record demographic, clinical, electrocardiographic and biological variables of SCD victims (including survivors of cardiac arrest) in several African cities. All deaths occurring in residents of districts of interest will be checked for past medical history, circumstances of death, and autopsy report (if possible). We will also analyse the employment of resuscitation attempts during the time frame of sudden cardiac arrest (SCA) in various patient populations throughout African countries. Conclusion This study will provide comprehensive, contemporary data on the epidemiology of SCD in Africa and will help in the development of strategies to prevent and manage cardiac arrest in this region of the world.

BackgroundA population-based incidence estimates of Sudden Cardiac Death (SCD) in sub-Saharan Africa (SSA) is unknown. We sought to determine the epidemiology of SCD in Douala, Cameroon.Method and resultsDuring 12 months, 4 districts were randomly chosen to monitor all deaths. The COSA ("comité de santé") of each area registered every death, and a postgraduate fellow recorded detailed demographic and medical data for victims of natural death. A senior physician studied every case of suspected sudden death, either cardiac or extra-cardiac. For optimal exhaustiveness, surrounding hospital mortuaries were checked simultaneously to match identities of victims. Established SCD was defined as rapid witnessed collapses leading to death within 1h after the onset of symptoms, and probable SCD as unexpected death within 24h without obvious extra-cardiac cause. Our registry numbered 240 000 people and 2304 deaths. The overall mortality rate was 11.2/1000 inhabitants/year. Four (0.3%) were sudden extra-cardiac death, and 58 (2.5%) SCD of which 41.4% were established and 48.3% had

Background Brugada syndrome (BrS) requires implantation of cardioverter- defibrillator (ICD) to prevent sudden cardiac death. However, the ICD indications in asymptomatic patients are remain conflicting. Method and Results We compared the rate of ICD complications in asymptomatic versus symptomatic BrS patients. ICD interrogations were done every 3-6 months. Given the low prevalence of BrS in the general population, 10% of the risk a?for the bilateral statistical test significance was chosen. We studied 51 patients, 86.5% male; mean age 4711 years at diagnosis. At diagnosis, 18 patients (35%) were asymptomatic, 25 patients (49%) experienced syncope, and 8 patients (16%) had been resuscitated from ventricular fibrillation. During a mean follow-up of 78±months, none of asymptomatic patients experienced appropriate therapy, whereas 21.6% of symptomatic patients had =1 shocks. Overall complication rate was 27.4%. Inappropriate shocks (IS) occurred in 7 patients (13.7%; mean 6.57±4 shocks per patient), 16.14±38 months after ICD implantation, and lead fracture was the first cause (n=4, 57.1%). The incidence of IS was higher in the asymptomatic patients (p=0.09). Device-related complications were similar in both groups (p=1). A total of 14 patients (27.4%) had =1 complications. The mean interval from implantation to a complication was 13.91±98 months. The most frequent complication was lead failure in 9 (17.6%). The risk of IS and device-complications at 3 years was 13.7% and 21.6% respectively, and eventually remains constant over the time. Conclusion This study demonstrated that ICD has a high risk of complications, mainly during the early period after the device implantation. A higher rate of IS as well as a very low risk of arrhythmic events in asymptomatic BrS patients advocate to carefully evaluate this young and otherwise “healthy” population for the decision-making.

O4.1 BRIEF MOTIVATIONAL INTERVENTION TO REDUCE ALCOHOL CONSUMPTION IN YOUNG PATIENTS IN A FRENCH EMERGENCY DEPARTMENT {#article-title-2} Background. Alcoholic intoxication (AI) in young people is an important problem in emergency departments (EDs). Aim - To establish the effectiveness of a Brief Motivational Intervention (BMI) in reducing alcohol consumption among young patients admitted in a French ED for AI. Methods. Two-group simple blind randomised controlled trial. From September 2011 to July 2012, patients aged 16 to 24 who tested positive for blood alcohol content of 0.5g/l or above were randomised, with stratification according to patient's age (16-17 or 18-24), between intervention (BMI performed by a psychologist in the ED setting followed by a phone booster session at one and two months) and controls (delivery only of an information leaflet and a list of addresses of services for alcohol misuse). The principal criteria used to assess the reduction of alcohol use at 3 months follow-up was the number of alcoholic drinks in the last week. Results. A total of 263 patients (controls 131, intervention group 132, mean age 20, men 72%) were randomized. Attrition accounted for 38% in controls and 43% in intervention group. Data analysis was conducted for a Poisson frequency distribution and showed no significant difference in effectiveness between the two conditions (OR 0.93 [0.64; 1.36]). All secondary outcomes were also not influenced by the intervention (including the number of AIs in the last month). Conclusions. This study did not detect a significant effect of Brief Motivational Intervention in reducing alcohol consumption after hospitalization for alcoholic intoxication in emergency department in young people. # O4.2 HARMFUL ALCOHOL CONSUMPTION IN HEALTH-WORKERS: RESULTS OF A SCREENING STUDY {#article-title-3} Background. In Italy national alcoholism risk prevention programs to assess number for year of accidents in health workplaces is actually in progress leaded by Health Minister and Regional administration. Particularly, prevention program acts consist in comprehensive informations for health workers and their co- workers, about prevention and identification of alcoholism related risks. Aims. To assess the rate of harmful alcohol consumption in a population of health workers in Padua. Materials and methods. Modified CAGE questionnaire was sent to 5590 health-workers in Padua. Anonymous questionnaires were collected in dedicated boxes. Results. 654/5590 (11.7%) subjects performed the test (M: 150, F: 504, mean age 42.9 yrs, range 28-65). The professional role was nurse in 300/654 (45,9%), physician 83 (12,7%), administrator 80 (12,2%), other 191 (29,2%). 57/654 (8.7%) had positive questionnaire for alcohol abuse or dependence: 33/57 (57,9%) had suspicion, 15 (26.3%) high probability and 9 (15.8%) were certainly alcohol abusers. 37/504 females (7,3%) and 20/150 males (13,3%) showed positive CAGE test. The professional role indicated positive test in 26/300 (8,7%) nurses, 9/83 (10,8%) physicians, 1180 (1,2%) administrator and 21/191 (11%) other professional roles. Conclusions. The number of tests performed is unsatisfactory, particularly among males and physicians. Our data suggest that harmful alcohol consumption is present in health-workers, more frequently in male sex. Physicians demonstrate an high prevalence of positive test. These data also suggests that the awarness of alcohol related problems doesn't reduce the probability of harmful consumption. A screening study can be useful to identify harmful alcohol users among the selective population of health-workers. # O4.3 BRIEF INTERVENTION IN PRIMARY HEALTH CARE FOR ALCOHOL USERS: AN EXPERIENCE IN PORTUGAL {#article-title-4} Introduction. The professionals of primary health care have a crucial role in screening individuals with risk consumption and harmful alcohol. The effectiveness of brief interventions in reducing alcohol consumption however, in Portugal its use is not yet widespread in particularly in primary care. Objective. to evaluate the effect of Brief Interventions in reducing excessive alcohol consumption on users accessing health center services, Coimbra, Portugal. Methods. A pre-trial, with a single group, and the assessment before the intervention (5 months). The sample included 45 patients (19 females, Mean= 48 age, SD = 15.199), enrolled in the Health Center Ansiao. We used a structured interview, using a questionnaire that included the AUDIT (Alcohol Use Disorders Identification Test), to evaluate the level of risk in relation to alcohol consumption. Interventions were made by previous protocol based on the level of risk identified, for data analysis resorting to the Wilcoxon test. Results. At baseline: 86.7% were at risk level I, 11.1% in the risk level II and 0% in the risk level III. In folow-up five months after the brief interventions, 95.6% were at risk level I, 2.2% in the risk level II and 0% in the risk level III. There was a positive effect on the progress of participants in respect to the levels of risk, with statistical significance (p = 0.046). Conclusions. Brief Interventions took effect in lowering and stabilizing the risk levels of alcohol consumption, reinforcing the importance of integration of Brief Interventions in Primary Health Care. # O4.4 UNIVERSAL SCHOOL-BASED PREVENTION INTERVENTION AND ALCOHOL USE {#article-title-5} Background. The Unplugged, a prevention intervention based on the Comprehensive Social Influence model, was implemented to reduce the risk of alcohol use in Czech adolescents. We investigated the effect of the Unplugged on the reduction of drunkenness. Methods. A randomized controlled prevention trial was conducted over 33 months. 1,874 6th-graders (mean age 11.82 years) completed the baseline testing. We compared self-reported drunkenness in control and intervention groups. Using logistic regression we study relationship between drunkenness and other variables such as gender, peer and parents effect, leisure time, ideas of hurting oneself, safe sex and school grades. Results. We find a significant effect of the Unplugged on the reduction of drunkenness. Male adolescents with unstructured leisure time activities and lower parents control report higher frequency of drunkenness. Idea of hurting oneself and unsafe sex is also associated with higher risk of getting drunk. Conclusion. We present evidence on the composition of risk profiles in adolescents who are engaged in high-risk alcohol consumption. Besides the intervention a screening tool should be used to identify adolescents who are eligible for complementary selective and/or indicated prevention interventions.

Background Implantable cardioverter-defibrillator (ICD) the best treatment for secondary prevention in Brugada syndrome (BrS). However, asymptomatic patients are still being implanted, regardless the high rate of device complications. We compared the occurrence of complications in patients implanted an ICD in several French centers. Method and results: Consecutive BrS Patients implanted an ICD for primary or secondary prevention were studied. Per- and post-implantation complications, and ICD programming controls were recorded. Patients or relatives were also contacted by telephone to check last news (alive or died). We studied 51 patients (mean age of 46.7±10.5 years, 10% of female). Spontaneous type 1 ECG pattern was found in 40 (78%) of patients and atrial fibrillation in 6 (12%). Prior to ICD implantation, No symptom, Syncope, and aborted cardiac arrest were found in 19 (37%), 24 (47%), and 8 (16%) patients respectively. During a median follow-up period of 76±41.7 months (at 1 to 192), appropriate ICD shocks occurred in 11 (21.5%) patients of whom 90% had spontaneous coved type ECG, 40% had previous syncope and 60% already have experienced aborted SCD. Seven (13.7%) patients had inappropriate shocks (IS), of whom 5 (71.4%) in asymptomatic, 28.6% in syncope group, and none in resuscitated group. Other Complications were reported in 10 (19.6%) patients. Lead fracture, Lead dislodgement, pneumothorax, pocket infection, myocardial perforation, and re-operation for any reason occurred in 4 (7.8%), 2 (3.9%), 1 (1.9%), 1 (1.9%), 1 (1.9%), and 9 (17.6%) respectively. The incidence of IS is higher in asymptomatic vs symptomatic patients if we consider the confidence interval of 90% (p=0.07) in this rare disease, whereas other complications had similar rate occurrence. Conclusion ICD was shown to be an effective therapy in symptomatic patients, particularly in those with previous cardiac arrest. However, the high rate of device complications, mainly inappropriate therapies recommends to accurately assess the risk-benefit of cardioverter-defibrillator and avoid this treatment in asymptomatic patients.