The inaugural 2025 Cardiometabolic Summit in Saclay, France, aimed to (i) disseminate the latest research on cardiometabolic diseases (CMDs) from the Maghreb and/or Middle East and North Africa region; (ii) discuss CMD management and provide clinical practice suggestions for improving adherence and reducing clinical inertia; and (iii) suggest policy and clinical practice initiatives to improve outcomes in patients with CMDs. Cardiovascular disease (CVD) is the leading cause of death worldwide, with 80

Background/Objectives: In France, remote monitoring for chronic heart failure transitioned from the experimental ETAPES programme (Expérimentations de télémédecine pour l'amélioration des parcours de santé) to routine reimbursement in July 2023. Whether patient-reported experience remained similar during routine implementation in a real-world respondent population was unknown. This study compared satisfaction, usability, and perceived benefits among Satelia® Cardio users surveyed in 2020-2021 and 2024. Methods: This repeated cross-sectional study compared 978 adult users surveyed between August and December 2024 with 400 digitally literate users from the 2020-2021 reference cohort. Ten comparable items were analysed as the proportion selecting scores of 7-10. Differences were assessed using Pearson's chi-square test with Yates' continuity correction. Exploratory age-stratified analyses examined three usability items. Results: In 2024, 30.1% of respondents were aged ≥80 years. Overall satisfaction was similar (80.3% vs. 77.0%; p = 0.20). Two perception items showed higher unadjusted ratings: perceived improvement in treatment adherence (60.1% vs. 52.3%; +7.9 percentage points; p = 0.009) and perceived help to the treating physician (76.5% vs. 70.3%; +6.2 percentage points; p = 0.019); however, these findings remained exploratory after correction for multiplicity. Usability ratings were slightly lower in 2024, with the largest differences versus the aggregate 2021 reference among respondents aged ≥80 years; ratings among those aged <70 years were similar to 2021 values. The recommendation rate to other patients was high at 70.3%. The three most frequently reported perceptions of Satelia® Cardio were that telemonitoring was reassuring, useful and simple. Conclusions: During the routine-reimbursement period, satisfaction remained high in a respondent population in which 30.1% were aged ≥80 years. Two perception items showed higher unadjusted ratings, but these findings remained exploratory after correction for multiplicity. Descriptively lower usability ratings in the ≥80-year stratum warrant further evaluation and tailored support. Because the surveys involved independent, differently composed samples, causal and longitudinal conclusions cannot be drawn. These findings describe patient experience across two successive implementation contexts and should not be interpreted as evidence of a causal effect of reimbursement policy.

Leadless pacemakers' implantations in France are limited to centers with onsite cardiac surgery. However, these implantations are now possible in centers without onsite surgery in most European countries. Indeed, the rates of tamponade and cardiac perforation are very low. This article argues for the implantation conditions to be extended to centers with thoracic or vascular surgery (and not cardiac), as is the case for atrial fibrillation ablations, because these centers already have immediate surgical back-up, allowing the treatment of cardiac tamponade or perforation.

BACKGROUND:Diagnosis of cardiac amyloidosis (CA) is complex and implicates several medical specialists. CA is usually suspected based on symptoms ('red flags') and non-invasive imagery. Early diagnosis and appropriate treatment are critical in patients with CA. METHODS:The DIAM-ATTR survey assessed the diagnostic pathway, from the French healthcare professional's (HCPs) perspective, for patients with transthyretin amyloidosis (ATTR)-cardiomyopathy (CM). Between February and March 2023, 13,830 HCPs were solicited to complete a 35-question survey. RESULTS:Among the 13,830 HCPs solicited, 1264 HCPs completed the survey: 471 cardiologists, 186 internists, 148 nuclear medicine physicians, 125 geriatricians, 120 orthopaedic surgeons, 112 neurologists, and 102 rheumatologists. In general, echocardiographic abnormalities, heart failure, and a family history of amyloid neuropathy evoked CA. The knowledge of the 22 'red flags' assessed varied among specialists. Among HCPs, 70% had suspected an ATTR-CM: from 96% of cardiologist to 6% of orthopaedic surgeons. Complete diagnosis was performed by 48% of both cardiologists and internists. The other HCPs referred patients to colleagues for complete diagnosis. Overall, echocardiography was performed first, then gammopathy assessment and bone scintigraphy. Delays for examinations and difficulties varied among specialists. CONCLUSION:Overall, French HCPs prioritize diagnostic examinations for ATTR-CM as recommended. However, HCPs need an increased awareness of 'red flags' and the importance of excluding monoclonal gammopathies during diagnosis.

L’implantation des pacemakers sans sondes est réservée en France aux centres disposant de la chirurgie cardiaque sur site. Cependant, leur implantation a été élargie aux centres ne disposant pas de la chirurgie cardiaque sur site dans une majorité de pays européens. En effet, les taux de tamponnade et de perforation cardiaque des procédures d’implantations sont très faibles. Cet article plaide pour que les conditions d’implantation soient élargies aux centres disposant de la chirurgie thoracique ou vasculaire (et non cardiaque) tel que cela est le cas pour les ablations de la fibrillation atriale, car ces centres disposent déjà d’une couverture chirurgicale immédiate permettant de suturer une plaie cardiaque.

La stimulation de l’aire de la branche gauche (LBBAP) est une technique récente de capture des voies de conduction pour permettre une activation naturelle au niveau ventriculaire.Elle se positionne comme plus fiable sur le plan technique que la stimulation hisienne et peut corriger un bloc de branche gauche proximal. Dans ce contexte, de nombreux registres et les premières études randomisées de faible effectif ont évalué l’intérêt de la stimulation de l’aire de la branche gauche par rapport à la resynchronisation conventionnelle avec des résultats encourageant en faveur de la LBBAP. Des études randomisées plus robustes sont en cours. Un document de consensus a inclus cette stratégie comme possible en première intention et préconisée en cas d’échec de la resynchronisation conventionnelle. Les constructeurs développent du matériel dédié avec intégration de la stimulation LBBAP dans la sonde de défibrillation.

BACKGROUND Cardiac amyloidosis (CA) is an increasingly recognized cardiomyopathy with an associated risk of arrhythmias and conduction disorders; however, managing arrhythmias and conductive disorders remains largely undefined. OBJECTIVES This study aims to gather French expert experience on current practices and treatment strategies for managing arrhythmias and conduction disorders in CA. The main areas of interest included atrial fibrillation (AF) management, anticoagulation therapy, and criteria for implanting cardiac rhythm devices. METHODS A modified Delphi method was employed, involving a panel of 56 cardiologists and electrophysiologists specializing in CA. The panel evaluated 248 statements over 2 rounds. Consensus was defined as agreement from at least 66.7% of the panel, with strong consensus requiring more than 50% complete agreement. RESULTS Consensus was achieved on 177 out of 248 statements across 2 rounds (71%). Key agreements included 1) the necessity for regular Holter monitoring and anticoagulation therapy in high-risk scenarios; 2) a rhythm control management strategy, including the use of amiodarone and AF ablation, particularly in the early stages of the disease; and 3) the use of cardiac devices for advanced conduction disorders, with decisions influenced by disease staging and left ventricular ejection fraction. CONCLUSIONS Approximately 70% of the proposed statements achieved agreement among the experts, reflecting reasonable alignment on anticoagulation therapy, AF management, and implantable cardiac devices. However, the study also highlights the need for personalized, multidisciplinary management of arrhythmias and conduction disorders in CA and emphasizes the need for future research to develop evidence-based guidelines. (JACC Adv. 2025;4:101604) (c) 2025 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Le syndrome d'apnée obstructive du sommeil est caractérisé par des obstructions répétées des voies aériennes, entraînant une hypoxie intermittente et une fragmentation du sommeil. Il constitue un facteur de risque indépendant majeur de fibrillation atriale, avec une forte prévalence de syndrome d'apnée obstructive du sommeil chez les patients atteints de fibrillation atriale. Les mécanismes physiopathologiques incluent l’hypoxie intermittente, qui provoque une activation sympathique et un remodelage auriculaire, ainsi que les variations de pression intrathoracique négative favorisant l’arythmie. Le diagnostic repose sur la polysomnographie et des outils standardisés comme le système SCOPER. Le traitement de référence, la ventilation en pression positive continue, montre un effet bénéfique sur la progression et la récidive de la fibrillation atriale, bien que les résultats restent variables selon les études. La prise en charge intégrée du syndrome d'apnée obstructive du sommeil et de la fibrillation atriale, incluant notamment la gestion du poids, est essentielle pour optimiser les résultats cliniques. Des recherches supplémentaires sont nécessaires pour mieux cibler les patients et évaluer les différentes options thérapeutiques.

BACKGROUND:Defibrillation testing (DT) remains recommended during subcutaneous implantable cardioverter defibrillator (S-ICD) implantation due to limited supporting evidence. OBJECTIVES:The objective of this study was to evaluate the long-term impact of DT during S-ICD implantation. METHODS:The HONEST (coHOrte fraNcaise des dEfibrillateurs Sous cuTanés) study is a nationwide, ongoing observational study, including all S-ICD recipients in France (2012-2019). Five-year endpoints were centrally adjudicated, and propensity score-weighted analyses compared outcomes by DT status. RESULTS:Among 4,924 patients, DT was performed in 4,066 (82.6%), decreasing from 85.4% (2012-2014) to 66.9% in 2019 (P < 0.001). Nontested patients were older (51.2 vs 49.6 years; P = 0.007), had lower left ventricular ejection fraction (37.6% vs 43.3%; P < 0.001), and were more frequently implanted for primary prevention (68.0% vs 62.4%; P = 0.002) and structural heart disease (84.9% vs 76.8%; P < 0.001). DT-related complications occurred in 0.1%, including 2 deaths. Failure rate was 1.0%, with 87.8% undergoing corrective reinterventions. Independent predictors of DT failure were elevated shock impedance (≥89 Ω; OR: 4.60; 95% CI: 2.32-9.66; P < 0.001) and obesity (body mass index ≥30 kg/m2; OR: 2.17; 95% CI: 1.01-4.55; P = 0.007). After adjustment, DT omission was not associated with increased risks of overall mortality (HR: 1.17; 95% CI: 0.86-1.61; P = 0.313), cardiovascular mortality (HR: 1.04; 95% CI: 0.70-1.56; P = 0.846), sudden cardiac death (HR: 0.27; 95% CI: 0.04-1.72; P = 0.167), and appropriate (HR: 1.01; 95% CI: 0.78-1.30; P = 0.945) or inappropriate shocks (HR: 0.98; 95% CI: 0.78-1.23; P = 0.865). Combined rates of ineffective shocks or undetected ventricular arrhythmias were similar (0.05 vs 0.06 per 100 person-years). CONCLUSIONS:Our findings suggest that DT can be safely omitted in the majority of S-ICD recipients, whereas selective DT may be considered in higher-risk subgroups. (S-ICD French Cohort Study (HONEST); NCT05302115).

Left bundle branch block pacing (LBBAP) is a recent technique for capturing conduction pathways to allow physiological ventricular activation. It is technically more reliable than Hisian pacing and can correct proximal left bundle branch block. In this context, numerous registries and the first small randomized studies have evaluated the benefit of left bundle branch block pacing compared to conventional resynchronization therapy, with encouraging results in favor of LBBAP. More robust randomized studies are underway. A consensus document has included this strategy as a possible first-line option and is recommended in cases of failure of conventional resynchronization therapy. Manufacturers are developing dedicated equipment with LBBAP pacing integrated into the defibrillation lead.

Abstract Background The diagnosis of transthyretin cardiac amyloidosis (ATTR-CM) requires a good collaboration between physicians to confirm the diagnosis. Purpose This study aimed to assess current practices of nuclear medicine (NM) physicians for cardiac scintigraphy with bone radiotracers and to evaluate access to cardiac bone scintigraphy in the healthcare circuit for the diagnosis of ATTR-CM. Methods A nationwide electronic survey was sent to 13 830 French physicians including 775 nuclear medicine (NM) physicians to assess their knowledge of 1. clinical signs of amyloidosis and 2. the recommended diagnostic algorithm to identify TTR cardiac amyloidosis. In addition, accessibility, appointment delays and results interpretation difficulties for each of the explorations required to confirm the diagnosis of ATTR-CM were evaluated among different medical specialists. A part of the questionnaire was exclusively dedicated to NM to understand their current practice regarding acquisitions protocols and reporting of cardiac bone scans. Results 1264 physicians including 148 NM physicians (19 % of all NM physicians contacted) completed the survey. NM physicians who answered to the survey worked in academic hospitals (35 %), general hospitals (31 %), or private practices (26 %). Cardiac bone scans using early acquisitions were performed by 20 % of NM and SPECT acquisitions by 72 %. Grading of cardiac uptake of bone tracers using the Perugini score was carried out by 93 % of the NM, but only 31% and 5% of NM systematically performed heart/whole body or heart/mediastinum signal quantification, respectively. Median (Q1; Q3) delay to obtain results for a cardiac bone scan was estimated at 2 weeks (2; 4) compared to 4 (3; 8) weeks for cardiac MRI, and 2 (2 ; 4) weeks for a biopsy. Among physicians involved in clinical management of patients with ATTR-CM, 68% rarely or never faced difficulties for cardiac scintigraphy. Main difficulties encountered by physicians were: appointment delay (60%), geographical distance (17%), interpretation (12%). Conclusions In this large French national survey, access to cardiac bone scintigraphy for patients with a suspicion of ATTR cardiac amyloidosis and quality of reports appear excellent thanks to good adherence of NM physicians to the recommended acquisition protocols for cardiac bone scans and the widespread use of the Perugini grading scale in reports. However, quantitative measurements of cardiac uptake of bone tracers were performed only in one third of bone scans underscoring room for improvement in the next procedural guidelines for cardiac bone scans.

The diagnosis of transthyretin cardiac amyloidosis (ATTR-CM) is complex. Diagnostic includes numerous examinations and implicates diverse medical specialists. The objective of the DIAM-ATTR survey was to obtain a snapshot of the current ATTR-CM diagnostic pathway in France. An electronic survey was sent to almost 70% of the 20.067 French healthcare professionals (HCPs) potentially implicated in ATTR-CM diagnosis and representing both public and private practice throughout France. The "Réseau Amylose" and Cardiogen networks were implicated in developing and distributing the survey. The survey collected data concerning HCPs' levels of knowledge on ATTR-CM (particularly signs and symptoms), use of the recommended diagnostic algorithm, the diagnostic pathway, as well as the difficulties encountered during diagnosis, overall and according to each specialty. In total, 1264 physicians answered the survey (471 cardiologists, 186 internists, 148 nuclear medicine physicians, 125 geriatricians, 120 orthopaedic surgeons, 112 neurologists, and 102 rheumatologists). The levels of knowledge with respect to the signs and symptoms suggesting ATTR-CM differed between HCPs according to specialty, see Figure 1. Regarding the diagnostic pathway, among the 719 HCPs diagnosing ATTR-CM, most adhere to the current diagnostic algorithm with almost all respondents performing bone scintigraphy and monoclonal gammopathy. However, some diagnostic examinations such as genetic testing were not systematically performed (36% to 93% depending on specialty). The healthcare pathway (including numbers of patients seen with suspected ATTR-CM, referral patterns, numbers and order of examinations performed), as well as difficulties encountered for ATTR-CM diagnosis varied among specialists. The predominant difficulty pertained to confirming the type of amyloidosis by biopsy. The French DIAM-ATTR survey shows that in a large cohort of HCPs, the recommended diagnostic algorithm for ATTR-CM is mostly followed although further HCPs education on clinical signs associated with ATTR-CM is needed. The survey identified several difficulties in the diagnostic pathway of the disease that should be overcome to improve ATTR-CM patients management.

Background: A new ESC guidelines in 2023, the International Lipid Expert Panel (ILEP) 2021 recommendations, and a subsequent statement by EAS have been published based on recent advances in lipid lowering treatments. However, real world data are lacking regarding the implementation among the community of French cardiologists. Objective: To determine the current approach and therapeutic strategies concerning lipid lowering treatments post-acute coronary syndromes in France. Methods: This national survey was performed during October and November 2023 in France with an online questionnaire on the websites of 2 national French Societies of Cardiologists. Four mailings were sent to cardiologists to invite them to answer to the questionnaire. A total of 400 answers of cardiologists were collected during this 2-month period. Results: For ASCVD patients, cardiologists agreed with an LDL-C goal below 55 mg/dL (1.4 mmol/L) in 69%, below 70 mg/dL (1.8 mmol/L) in 16.5%, and 14.5% between 70 mg/dL and 100 mg/dL (1.8-2.5 mmol/L). An upfront lipid lowering combination strategy using fixed dose combination (FDC) of statins and ezetimibe was prescribed in less than 5% of patients, whereas high-intensity statins were prescribed in more than 90% of patients. No significant differences were observed in terms of sex of patients, geographical area, or strategies followed by male and female cardiologists ( p > 0.05). A combination of statins and ezetimibe was prescribed only for a minority of patients, especially as an early upfront strategy. The use of PCSK9i remains marginal and the interval between the ACS and initiation of these medicines remains high. Conclusion: In this contemporary national survey, we report an excellent agreement of lipid goals in secondary prevention by cardiologists. Despite the declared consensus recommending a low LDL-C target in ACS patients, lipid lowering strategies are suboptimal, mainly consisting of high intensity statins. The lack of recommended use of ezetimibe and PCSK9i to lower LDL-C levels highlights the importance of better implementation of intensive and early upfront strategies to reduce recurrent ischemic events.

INTRODUCTION:The use of telehealth, such as remote patient monitoring (RPM), for chronic heart failure (CHF) impacts patient pathways. Patient-centricity in chronic disease management is valuable. Even though RPM is recommended in practice, the evaluation of patient satisfaction has been limited to date. The objective of this study was to assess the perceptions and satisfaction of patients with CHF when using RPM.METHODS:A voluntary declarative survey was conducted with users of Satelia® Cardio, an RPM web application which was included in an experimental model program in France funded by the ETAPES program initiative sponsored by the French Ministry of Health. Monitoring was based on patient-reported outcomes (seven questions on symptoms, one question on weight) which were answered online (digitally literate patients) or by phone with a nurse (patients with poor digital literacy). The survey included questions on perceived usefulness, ease of use and impact on quality of life (QoL).RESULTS:Overall, 87% of the 825 patients were satisfied with having their CHF digitally monitored. Patients found that the application was easy to use (94%), problem free (95%), provided well-timed notifications (98%), easily accessible (96.5%), understandable (89%), and did not require an unreasonable amount of time to answer questions (99%). Most patients felt that RPM helped physicians provide better care during their follow-ups (70%, mean score: 7.98/10) and 45% of the digitally literate patients indicated an improved QoL.CONCLUSION:Poor digitally literate patients may need human-based or assisted RPM. Patients monitored daily for CHF through RPM expressed strong satisfaction and acceptance.

BACKGROUND:Electrical storms (ES) are serious cardiac emergencies associated with increased short-term mortality. The true incidence of ES in patients with an implantable cardioverter defibrillator (ICD) is still difficult to estimate because of the heterogeneous definition. The clinical presentation is variable and its management is multidisciplinary. OBJECTIVE:The aim of the study was to analyze the epidemiological profile and evolution of a group of patients implanted with an ICD who had electrical storms detected by a home monitoring system. METHODS:This is a single-center retrospective observational study, which included 14 patients who were implanted with ICDs, for primary or secondary prevention between 2008 and 2021. All of them were followed by home monitoring. All these patients had an ES detected by home monitoring and authenticated by ECG. RESULTS:The mean age of the patients at the time of onset of the electrical storm was 75.4 ± 14.5 years, with extremes ranging from 49 to 101 years. Most of patients (n = 11) were male. The majority of them had underlying ischaemic cardiomyopathy (n = 12). In a third of cases (n = 5) patients were implanted for secondary prevention. The electrical storm was related to recurrent episodes of VT. No cases of VF were detected. Syncope was the most frequent clinical presentation (four patients). Nine patients received internal shocks, with an average of four shocks per patient. The triggering factor was myocardial ischaemia in four cases. Majority of patients were managed in the cardiac intensive care unit. Two patients were admitted to the intensive care unit. In addition to anti-arrhythmic treatment with amiodarone and beta blockers. Nine patients underwent ablation of ventricular tachycardia focus. Mortality was high (in half of the cases) mainly due to a cardiogenic shock. CONCLUSION:This study shows that OR remain rare, but are still associated with high mortality. Home monitoring makes it possible to manage them earlier.

Aims The study aims to investigate the impact of direct oral anticoagulant (DOAC) management on the incidence of pocket haematoma in patients undergoing pacemaker or implantable cardioverter-defibrillator implantation. Methods and results All consecutive patients receiving DOAC and undergoing cardiac electronic device implantation were included in a large multicentre prospective observational study (NCT 03879473). The primary endpoint was clinically relevant haematoma within 30 days after implantation. Overall, 789 patients were enrolled [median age 80 (IQR 72-85) years old, 36.4% women, median CHA(2)DS(2)-VASc score 4 (IQR 0-8)], of which 632 (80.1%) received a pacemaker implantation. Antiplatelet therapy was combined with DOAC in 146 patients (18.5%). Direct oral anticoagulants (DOACs) were interrupted 52 (IQR 37-62) h before the procedure and resumed 31 (IQR 21-47) h later. Ninety-six percent of the patients had at least 12 h DOAC interruption before the procedure, and 78% had at least 12 h DOAC interruption after the procedure. Overall, anticoagulation was interrupted for 72 (IQR 48-96) h. Pre- or post-procedural heparin bridging was used in 8.2% and 3.9%, respectively. Timing of DOAC interruption of resumption was not associated with clinically relevant haematoma. Clinically relevant haematoma occurred in 26 patients (3.3%), and thromboembolic events occurred in 5 patients (0.6%). Conclusion In this large real-life registry where most patients had DOAC interruption, clinically relevant haematoma was rare. Despite DOAC interruption and high CHA(2)DS(2)-VASc score, thromboembolic events occurred seldomly, highlighting that bleeding exceeds thromboembolic risk in this peri-procedural period. Future research is needed to identify risk factors for clinically relevant haematoma and meaningfully guide clinicians in optimizing DOAC management.