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Background. - Reversion of an implantable cardioverter defibrillator (ICD) to back-up mode degrades the operating capabilities of the device, puts patients at risk and requires rapid intervention by a manufacturer's technician. Aim. - To illustrate the usefulness of remote monitoring of ICDs for the early detection of reversion to back-up mode. Methods. - In our centre, all patients implanted with an ICD, with or without resynchronisation, were offered remote monitoring as soon as the technology became available. Alerts triggered by the remote monitoring system were included prospectively in a register. During a mean follow-up of 5.7 +/- 1.3 years, a total of 1594 patients with an ICD (441 with resynchronisation function) followed with remote monitoring were included in the register. Results. - Among 15,874 alerts, only 10 were related to a reversion to back-up mode. Among those, seven reversions were caused by radiotherapy, two were fake events and one was caused by magnetic resonance imaging. Except for the two fake events, the eight other patients had an emergency admission for the resetting and reprogramming of their ICD. None of the reversion to back-up mode alerts was followed by a clinical alert (i.e. a shock alert) before the ICD problem was resolved. Conclusions. - Reversion to back-up mode is a very rare event, accounting for 0.06% of total alerts; remote monitoring facilitates the early detection of this critical event to resolve the problem faster than the next scheduled follow-up. Remote monitoring can prevent serious dam-age to the patient and avoids systematic ambulatory control of the ICD after each radiotherapy session. (c) 2021 Elsevier Masson SAS. All rights reserved.

Introduction Several clinical studies have demonstrated that remote monitoring (RM) offers potential benefits in transvenous implantable cardioverter defibrillator (ICD). The potential interest of RM in subcutaneous-ICD (S-ICD) recipients has never been evaluated. The aim of this study was to evaluate the alert burden and its clinical relevance in a prospective cohort of S-ICD recipients. Methods We prospectively and consecutively enrolled all patients undergoing S-ICD implantation at Lille University Hospital from September 2015 to January 2017 and gave them a LATITUDE (TM) NXT RM system. The relevance of transmissions was assessed by the following ratio: number of transmissions leading to reaction or intervention per patient/number of transmissions per patient. Results From September 2015 to January 2017, 69 patients were enrolled with a mean follow-up of 415 +/- 96.3 days. The mean age was 44.6 +/- 15.6 years old, and 25% (n = 17) had ischemic cardiomyopathy. At the end of follow-up, 12% of the patients had events recorded by RM. These events were related to nine ICD shocks and eight untreated events. A total of 1,423 transmissions were collected. Most of these transmissions were patient-initiated without any event (77%, n = 1,096) or scheduled without any event (19%, n = 272). Only 3.2% +/- 1.1 of the transmissions per patient led to reactions or interventions. Conclusion On the basis of the current method of transmitting, S-ICD RM allowed detection of relevant events in 12% of patients but generated a high unactionable transmission burden. As a result of these findings, efforts should be made to optimize transmissions considering automatic transmissions and to focus on patient education.

Atrial high rate episodes (AHREs) detected by cardiac electronic implantable devices are common. They are significantly associated with mortality and morbidity due to systemic embolism and ischemic stroke. Much earlier detection of AHREs might allow the timely introduction of therapies to protect the patient. The aim of this study was to determine the incidence and risk factors of AHREs in patients with implantable defibrillator in the era of remote monitoring (RM), and to analyze the choice of anticoagulant treatment strategies and its potential complications. 1226 patients with implantable cardioverter defibrillator remotely followed-up were prospectively included from January 2009 to December 2016 at Lille University Hospital. The first phase of the study focuses primarily on the incidence and risk factors of AHREs and the second analysis was confined to patients presenting at least one AHRE. Survey analysis was determined using the Kaplan-Meier method and compared between groups with the Logrank test. Among the 1226 patients, 63 presented at least one AHRE detected by RM which corresponds to an incidence of 5.14%. In ¾ of cases, the AHRE was completely asymptomatic. In the remaining quarter, the most common symptom was dyspnea. The main precipitating factor was infection. AHRE risk factors were thyroid dysfunction (p = 0.0047) and left atrial enlargement (p = 0.0317). None of these factors were associated with atrial fibrillation duration. The mean CHA2DS2-VASc score was 2.64 ± 1.38. Oral anticoagulation therapy was introduced in 47 patients (88.7%). The incidence of thromboembolic events was 1.6% and that of anticoagulation-related hemorrhagic complications was 8.5% (n = 4) with ¾ major. AHRE is a common disease. Risk factors are thyroid dysfunction and left atrial enlargement. Its thromboembolism risk seems to be low. The introduction of anticoagulation therapy is based on the evaluation of clinical risk scores for systemic embolism and its indication must be regularly assessed because hemorrhagic complications are common.

AIMS:Despite increased use of remote monitoring (RM) to follow up implantable cardioverter-defibrillator (ICD) recipients, many patients still receive ICD shocks in the community and present to the emergency department. Our aim was to identify the best predictors of impending shock delivery that can be measured with an ICD and to identify the most appropriate activities to alert physicians to during RM follow-up.METHODS AND RESULTS:All patients presenting to our institution for ICD shock, from November 2011 to November 2014, were enrolled in this prospective study. Patient characteristics, investigation results, and details of electrical activities from ICD interrogation were recorded at presentation. Presentations were classified as potentially avoidable if activities from a list of set criteria were apparent more than 48 h before index shock. Univariate and multivariate analyses were then used to identify predictors of potentially avoidable shocks. In total, 109 emergency presentations were recorded in 90 patients (male: 85%; 57 ± 16 years; ischaemic cardiomyopathy: 49%; LVEF: 34 ± 13%; electrical storm: 40%), of which 26 (24%) were potentially avoidable. Antitachycardia pacing (ATP) episodes were the most important predictor of impending shock. Potentially avoidable shocks were preceded by more episodes of ATP than unavoidable shocks (13 [3-67] vs. 3 [0-10]; P < 0.001). Patients followed up with RM systems configured to generate alerts following ATP delivery experienced significantly less ICD shocks (24 vs. 16%, P < 0.01).CONCLUSION:Remote monitoring systems that generate alerts following ATP delivery could reduce emergency presentations for ICD shock by 24%, as ATP is a key predictor of impending shock delivery.

The nurse is at the heart of the caregiving relationship in the remote monitoring of patients with heart failure equipped with an implantable device. Her direct contact with the patient erases the distance imposed by telemonitoring and her close connection with the cardiologist-arrhythmia specialist ensures the patient follow-up is optimal. After her training in telemedicine, the nurse plays a key role in the telerhythmology activity.

The nurse is at the heart of the caregiving relationship in the remote monitoring of patients with heart failure equipped with an implantable device. Her direct contact with the patient erases the distance imposed by telemonitoring and her close connection with the cardiologist-arrhythmia specialist ensures the patient follow-up is optimal. After her training in telemedicine, the nurse plays a key role in the telerhythmology activity.

Purpose: To evaluate the outcome of patients with DR-ICDs and active RM.Methods: A total of 283 patients with 91,632 RM transmissions collected over a 15-month follow-up (FU) and who were enrolled in the LION registry were included in the analysis.Atrial arrhythmia burden subgroups were defined as AB ¼ 0 (no AB on any day during FU) versus AB > 0 (AB > 0 on at least one day during FU).Only patients (n¼274) with a minimum of 45 RM transmissions and additional historical information of atrial fibrillation (AF) occurrence prior to enrolment were included in the analyses.Results: Of the 274 patients fulfilling the predefined criteria, 36.1% (99 patients) with AB > 0 and 63.9% (175 patients) with AB ¼ 0 during FU were identified.Based on the following baseline characteristics, subjects with AB > 0 differed from those without AB (p < 0.05): They were more frequently in a NYHA functional class III (AB ¼ 0: 15% vs. AB > 0: 31%, p ¼ 0.003), had a lower mean LVEF (AB ¼ 0: 36.6 6 13.6% vs. AB > 0: 33.1 6 12.2%, p ¼ 0.047) and had more frequently a history of AF (AB ¼ 0: 13% vs. AB > 0: 40%, p < 0.001).Furthermore, subjects with AB during FU were older (AB ¼ 0: 65.1 6 10.8 years vs. AB > 0: 67.5 6 10.1 years; p ¼ 0.071).There was no substantial difference between groups with respect to gender, body mass index, secondary prevention indication, non-cardiac medical history, and medication.Of the 211 patients without a history of AF, 28.0% (59 patients) developed de novo high rate atrial arrhythmias during FU.For 36.5% (23 patients) with a history of AF, an AB ¼ 0 was detected during the observational period.Conclusions: Due to their greater morbidity, the occurrence of atrial arrhythmia reflects an important issue for ICD patients.In this case, an optimal anticoagulation therapy might be potentially helpful in preventing the occurrence of embolic stroke.In our cohort, patients with AF detected by RM suffered from progressive heart failure, low ejection fraction, and had a previous history of AF.In addition, RM-based recording of AF might help to initiate a more individual anticoagulation strategy to prevent bleeding in course of continuous anticoagulation therapy. P1637

Les systèmes de télésurveillance des défibrillateurs automatiques implantables (DAI) proposent des alertes automatiques en cas de survenue de tachycardies supraventriculaires (TSV). Recenser l’ensemble des alertes spécifiques et non spécifiques des TSV et décrire leur prévalence. Dans un premier temps, les alertes notifiant les TSV ont été listées à partir de leur intitulé figurant sur les sites Internet des cinq systèmes de télésurveillance que sont : Home Monitoring™, Latitude Patient Management™, Carelink Network™, Merlin.net™ et Smartview™ ; puis elles ont été précisément définies. Les alertes non spécifiques de la survenue d’une TSV mais pouvant en être le témoin indirect ont également été recensées. Dans un deuxième temps, 2620 alertes recueillies sur une période de deux ans allant de septembre 2009 à septembre 2011 et provenant de 456 DAI simple chambre, double chambre ou équipés d’une fonction de resynchronisation ont été analysées. Cinq types d’alertes spécifiques et quatre types d’alertes non spécifiques ont été répertoriés. Il existait une relative hétérogénéité selon les systèmes de télésurveillance concernant leur dénomination, leurs critères diagnostiques et leur nombre. La prévalence a été de 564 alertes relatives aux TSV (21 %) dont 325 alertes spécifiques (12 %) et 236 alertes non spécifiques (9 %). La télésurveillance propose une large variété d’alertes permettant la détection des TSV avec une relative hétérogénéité des différents systèmes. Des études complémentaires sont nécessaires afin d’apprendre à les programmer et à les utiliser dans les différentes populations de patients porteurs de DAI. Remote monitoring systems of implantable cardioverter defibrillators (ICD) offer automatics alerts in case of occurrence of supraventricular tachycardia (SVT). To list all specific and nonspecific SVT alerts and describe their prevalence. At first, the alerts notifying SVT were listed from their name appearing on the websites of the five remote monitoring systems that are: Home Monitoring™, Latitude Patient Management™, Carelink Network™, Merlin.net™ and Smartview™. They were then precisely defined. Nonspecific alerts of SVT that could be their indirect indicator were also listed. In a second step, 2620 alerts collected over a period of two years from September 2009 to September 2011 and originating from 456 single or dual chambers ICD and ICD equipped with a cardiac resynchronization therapy were analyzed. Five specific types of alerts and four nonspecific types of alerts have been listed. There was a relative heterogeneity within the remote monitoring systems regarding their name, their diagnostic criteria and their number. Their prevalence was 564 alerts for SVT (21 %) including 325 specific alerts (12 %) and 235 nonspecific alerts (9 %). Remote monitoring offers a wide variety of alerts for the detection of SVT with a relative heterogeneity of the different systems. Further studies are needed to learn how to program and use them among different populations of patients equipped with ICD.

AIMS:Lead fractures in implantable cardioverter-defibrillator (ICD) patients may cause inappropriate shocks (ISs). An early diagnosis is essential to prevent adverse clinical events. Implantable cardioverter-defibrillator remote monitoring (RM) permits prompt detection of lead fracture. Limited data define the impact of RM on ISs specifically related to lead fracture. We sought to compare the number of ISs related to lead fracture in patients with vs. without RM follow-up.METHODS AND RESULTS:We checked the registry of our institution and collected, between July 2007 and June 2014, 115 cases of right ventricular lead fractures. All relevant data were documented from patients' files, device-interrogation printouts and electronic records, and remote transmissions databases when applicable. We assessed the ISs that were related to lead fracture. The first study endpoint was the number of ISs per shocked patient. Among the 82 patients with conventional follow-up (CFU) and the 33 patients with RM, a first IS occurred to 32.9% (n = 27) and 30.3% (n = 10, P = 0.83) of the patients, respectively. Shocked patients in the RM group underwent significantly fewer ISs with a mean of 6 ± 2 shocks per patient [median of 3.5 shocks (2-8)] than those in the CFU group with a mean of 18 ± 5 shocks per patient [median of 10 shocks (5-22), P = 0.03].CONCLUSION:Remote monitoring helps to reduce the burden of ISs related to ICD lead fractures.

BACKGROUND:Implantable cardioverter-defibrillators (ICDs) are a standard means of sudden cardiac death prevention. Compared with ambulatory visits, remote monitoring (RM) of ICD recipients has improved the quality of health care and spared its resources. Few studies have addressed the organization of RM. We optimized and validated our institutional model of RM organization for ICD recipients.METHODS AND RESULTS:This observational study of 562 ICD recipients compared 2 RM periods consisting of iterative, qualitative, and quantitative (1) device diagnostic evaluations by nurses and cardiologists; and (2) selected decisional trees. The main study end points were the professional interventions prompted by, and times allocated to, RM alerts. During the first period, 1134 alerts occurred in 427 patients (286 patient-year), of which 376 (33%) were submitted to cardiologists' reviews, compared with, 1522 alerts in 562 patients (458 patient-year), of which 273 (18%) were submitted to cardiologists' reviews during the second period (P<0.001). An intervention was prompted by 73 of 376 (19.4%) alerts in the first versus 77 of 273 (28.2%) in the second period (P=0.009). The mean time to manage an alert was 4 minutes 31 s in the first versus 2 minutes 10 s in the second period (P<0.001). The annual numbers of alert-related hospitalizations were 10.8 versus 8.1 per 100-patient-year (P=0.230), and annual numbers of alert-related visits were 9.8 and 6.1 per 100-patient-year (P=0.081), respectively.CONCLUSIONS:An optimized RM organization based on automated alerts and decisional trees enabled a focus on clinically relevant events and a decrease in the consumption of resources without compromising the quality of ICD recipients' care.

Lead fractures in implantable cardioverter-defibrillator (ICD) patients may cause inappropriate shocks. An early diagnosis is essential to prevent adverse clinical events. ICD remote monitoring permits prompt detection of lead fracture. Limited data define the impact of remote monitoring on inappropriate shocks related to lead fracture. To compare the number of inappropriate shocks related to lead fracture in patients with and without remote monitoring follow-up. We checked the registry of our institution and collected, between July 2007 and June 2014, 115 cases of right ventricular lead fractures. All relevant data were documented from patients’ files, device interrogations printouts and electronic records, and remote transmissions databases when applicable. We assessed the inappropriate shocks that were related to lead fracture. The first study endpoint was the number of inappropriate shocks per shocked patient. Among the 82 patients with conventional follow-up and the 33 patients with remote monitoring, a first inappropriate shock occurred in 32.9% (n = 27) and 30.3% (n = 10, P = 0.83) of the patients respectively. Shocked patients in the remote monitoring group underwent significantly lesser inappropriate shocks with a median of 3.5 [1.8 to 8.3] shocks per patient than those in the conventional follow-up group with a median of 10.0 [5.0 to 22.0] shocks per patient (P = 0.03). Remote monitoring helps to reduce the number of inappropriate shocks in symptomatic ICD lead fractures.

Implantable cardioverter-defibrillators (ICD) are a standard therapy to prevent sudden cardiac death (SCD). Remote monitoring (RM) of ICD patients provides healthcare quality improvement and resource savings compared with standard in-hospital visits. Only limited data exist about RM organizations. We aimed to evaluate and validate our institutional optimized RM organization model for ICD patients. This observational study compared two RM models with an iterative qualitative and quantitative approach in 562 ICD patients: RM1 with device diagnostics evaluation by nurses and cardiologists, and RM2 with a selected approach with decision trees for actions. The main endpoints were in-hospital professional actions and times related to RM alerts. During RM1, 1134 alerts occurred in 427 patients (286 patient-years) of which 376 (33%) were submitted to cardiologist review whereas during RM2, 1522 alerts occurred in 562 patients (458 patient-years) of which 273 (18%) were submitted to cardiologist review (P < 0.001). An active decision was triggered by 73/376 (19.4%) alerts in RM1 versus 77/273 (28.2%) in RM2 (P = 0.009). Mean time to manage a RM alert was 4 minutes 31 seconds for RM1 versus 2 minutes 10 seconds for RM2 (P < 0.001). Comparing RM1 vs. RM2, annual rates of alert-related hospitalizations were 9.4 and 7.9 per 100 patient-years (P = 0.50), while annual rates of alert-related in-hospital visits were 9.4 and 6.1 per 100 patient-years (P = 0.11). In ICD patients, optimized RM strategy based on automatic alerts and decision trees allows to focus on clinically relevant events and to reduce healthcare resources without compromising quality.

Évaluer la connaissance des échographistes des recommandations du Comité technique national de l’échographie (CTE) concernant l’échographie de deuxième trimestre.Étude par questionnaire diffusé par courriel aux échographistes par l’intermédiaire des sociétés savantes (CFEFE, CNGOF) et des réseaux de soins périnataux, portant sur des éléments démographiques, la pratique de l’échographie du deuxième trimestre et les recommandations du CTE. Des comparaisons de proportions ont été faites en utilisant le t test de comparaison de proportion (logiciel XlStat 2008, Addinsoft, Paris, France).Sur 684 réponses obtenues, 653 (95 %) font des échographies du deuxième trimestre et 635 sur 653 (97 %) savent qu’il existe un rapport du CTE. Le taux de réponses correctes concernant la nature des clichés biométriques recommandés varie entre 97 % et 100 %. Pour les clichés morphologiques, les taux sont plus variables avec des taux de bonne réponse entre 52 et 100 %. Une analyse en sous-groupes (avoir lu les recommandations ou pas) montre que ceux qui ont lu les recommandations ont les meilleurs résultats de façon significative.Les recommandations nationales servent à promouvoir une politique d’assurance qualité de l’échographie et peuvent être opposables en cas de problème médicolégal. Il faut que d’une part, les sociétés savantes qui émettent des recommandations améliorent la diffusion de leurs travaux et que d’autre part, les praticiens de santé fassent des efforts de formation médicale continue et d’application des recommandations dont ils ont connaissance.To evaluate the sonographers’ knowledge of the National Technical Committee of Ultrasound's recommendations concerning second trimester ultrasound.Anonymous questionnaire was sent by e-mails containing 25 questions about demographic elements, the practice of second trimester ultrasound and the recommendations of the National Technical Committee of Ultrasound about second trimester ultrasound.Six hundred and eighty-four responses were obtained. Six hundred and fifty-three upon 684 (95%) of respondents practice second trimester ultrasound and 635 upon 653 (97%) know about the existence of the report of the National Technical Committee of Ultrasound. The rates of correct answers concerning recommended biometrical images vary between 97% for the biparietal diameter and head circumference, 98% for abdominal circumference and 100% for the femur length. While for morphological images, rates vary between 52% and 100%. A subgroup analysis (whether the respondents have already read the recommendations or not) showed that those who had read the recommendations have significantly better results than those who did not.Those who have already read the recommendations have better knowledge and global knowledge can be improved. National recommendations serve to promote a policy of quality assurance of ultrasound and may be used in medicolegal issues. The societies that make recommendations should more diffuse their work and practitioners should make effort to pursue the continuing medical education and to implement the recommendations.