[Supply of sterile medical devices to an interventional technical platform via mobile RFID technology]. / Approvisionnement d'un plateau technique interventionnel en dispositifs médicaux stériles via la technologie RFID mobile.

This work presents the eight-month assessment of the mobile RFID (radio frequency identification) technology implementation for the management of sterile medical devices in an interventional cardiology department. Several indicators dedicated to stock management, organizational impact (within the pharmacy and the department) and economic impact were collected. The scope of MDS tracked by RFID was defined as well as the new supply circuit. In total, 297 (83%) references were managed by RFID. At eight months, the number of MDS units in stock has decreased by 35% and the number of overstocked references by more than 50%. The value of the inventory decreased by €30,196 (17%) in three months from an initial amount of €17,995. This decrease has been maintained at eight months. The average time spent by the pharmacy technician (PPH) was 66min/d. The paramedical team gained 180min/week. By integrating the cost of the equipment, the annual subscription and the PPH cost, the benefit is estimated at €9555 the first year (then €17,155 the following years). To conclude, RFID has allowed a significant reduction of the stock and its control over time while securing the supply circuit adjusted to the activity. The limits are the absence of interface between the dedicated software and the ordering software as well as the consequent time dedicated by the PPH to this new management mode.

[Heart failure treatments]. / Les traitements de l'insuffisance cardiaque.

Heart failure is a frequent pathology in the elderly. In particular, it is responsible for many hospitalizations. A distinction is made between chronic and acute forms of heart failure. The management of these forms of heart failure is well established, with treatment recommendations that are regularly updated on the basis of new studies.

[Educational needs and implantable medical devices: How to meet the expectations of patients with coronary stents and heart valves?] / Besoins éducatifs et dispositif médical implantable : comment répondre aux attentes des patients porteurs de stents coronaires et valves cardiaques ?

At the Grenoble Alpes University Hospital Center, patients with cardiovascular disease have the opportunity to participate in a therapeutic education program in the cardiac rehabilitation department. The objective of this study is to analyze the educational needs of patients with coronary stents and heart valve prostheses. Using an exploratory qualitative method, semi-structured research interviews were conducted with 22 patients and an inductive thematic analysis was performed. We found that emergency surgery does not facilitate the assimilation of information in comparison with a scheduled procedure. The image of the "repaired heart" creates a cognitive conflict with the chronicity imposed by secondary preventive monitoring, a particularity of the implantable medical device. Patients feel that the information they receive is sometimes too voluminous and not adapted to their current needs. Thus, we propose an individualized support model based on the respect of temporality and on the psycho-behavioral functioning of the patient.

[Nurses at the heart of a cooperation protocol in rhythmology]. / Les infirmiers au cœur d'un protocole de coopération en rythmologie.

The cooperation protocol system allows healthcare professionals to engage in a cooperative approach to better meet patients' needs. The aim of these protocols is to offer a wider range of care by reducing access times and optimizing the patient's care pathway. Here is an example of an innovative approach taken in this context within a hospital rhythmology unit.

[Interventional cardiology in the elderly, at the time of TAVI and left atrial appendage occlusion]. / Cardiologie interventionnelle chez le sujet âgé.

Interventional cardiology is increasingly being offered to frail elderly people thanks to significant technical progress. Transcatheter aortic valve implantation allows the treatment of aortic stenosis by implanting an aortic bioprosthesis through a catheter, without surgery. The left atrial appendage occlusion limits the risk of ischemic stroke in patients with atrial fibrillation who have a contraindication to anticoagulants. These procedures remain invasive and must be proposed after multidisciplinary consultation.

The CRAC cohort model: A computerized low cost registry of interventional cardiology with daily update and long-term follow-up.

OBJECTIVES: To assess the reliability and low cost of a computerized interventional cardiology (IC) registry to prospectively and systematically collect high-quality data for all consecutive coronary patients referred for coronary angiogram or/and coronary angioplasty. BACKGROUND: Rigorous clinical practice assessment is a key factor to improve prognosis in IC. A prospective and permanent registry could achieve this goal but, presumably, at high cost and low level of data quality. One multicentric IC registry (CRAC registry), fully integrated to usual coronary activity report software, started in the centre Val-de-Loire (CVL) French region in 2014. METHODS: Quality assessment of CRAC registry was conducted on five IC CathLab of the CVL region, from January 1st to December 31st 2014. Quality of collected data was evaluated by measuring procedure exhaustivity (comparing with data from hospital information system), data completeness (quality controls) and data consistency (by checking complete medical charts as gold standard). Cost per procedure (global registry operating cost/number of collected procedures) was also estimated. RESULTS: CRAC model provided a high-quality level with 98.2% procedure completeness, 99.6% data completeness and 89% data consistency. The operating cost per procedure was €14.70 ($16.51) for data collection and quality control, including ST-segment elevation myocardial infarction (STEMI) preadmission information and one-year follow-up after angioplasty. CONCLUSIONS: This integrated computerized IC registry led to the construction of an exhaustive, reliable and costless database, including all coronary patients entering in participating IC centers in the CVL region. This solution will be developed in other French regions, setting up a national IC database for coronary patients in 2020: France PCI.

[Coronary calcified and resistant lesions angioplasty in the outpatient, myth or reality?] / Lésions coronaires calcifiées et résistantes en ambulatoire, mythe ou réalité ?

Progress in coronary angioplasty has enabled outpatients treatment with rates of immediate complications below 1%. This shows a clear improvement in patient's comfort and it represents an important medical and economic gain. Considering the demographic evolution of the population, there is an increasing number of calcified coronary lesions which represent, according to the series, up to a quarter of angioplasties. However, their care is more delicate with a greater risk of complications and procedural failure. In fact, with the difficulties of crossing and with the vascular intrusions related to pre-dilation or sub-dilation stent deployment, the complication risk increases by almost 10% in these cases of angioplasties. Similarly, the death rate at 30 days goes from 4.7% in angioplasty in general up to 24.4% in calcified lesions. Several devices for atherectomy and plaque preparation have been developed in order to better overcome the lesions and better prepare the stent installation at the cost of a risk of complications between 2 and 10%. The three most frequent complications are dissection (1.8 to 7%), slow/no-flow (0.1 to 3%) and coronary perforation (0.2 to 4%). Nevertheless, despite this procedural increased risk, ambulatory angioplasty of calcified complex lesions can become a reality subject to 4-6 hours monitoring in a specialized unit with dedicated protocols.

[Outpatient coronary angiography and percutaneous coronary interventions before and after the COVID-19 pandemic: experience of the Versailles hospital centre]. / Coronarographie et angioplastie coronaire ambulatoire avant et après la pandémie de COVID-19 : expérience du centre hospitalier de Versailles.

BACKGROUND: Same day discharge (SDD) diagnostic coronary angiography and percutaneous coronary interventions (PCIs) are increasingly performed, and indications extend to more complex procedures and more fragile patients. We report the evolution of SDD interventional cardiology activity in our centre since 2016, particularly before and after the COVID-19 pandemic. Secondarily, we analysed the feasibility and safety of SDD PCI. MATERIALS AND METHODS: We analysed the number and percentage of SDD coronary angiograms and PCIs (elective or ad hoc), during 4 periods of 11 months each, from September 2016 to July 2024. Periods 1 and 2 took place before COVID-19, periods 3 and 4 after. We also compared the rate of complications and conversion to hospitalisation between periods 1-2 and 4. RESULTS: A total of 9587 procedures were analysed, including 1558 SDD procedures. The total number of SDD interventional cardiology procedures increased progressively over the 4 periods, from 146 SDD procedures (7.5%) in 2016-2017 to 620 (27.2%) in 2023-2024. This increase included both diagnostic coronary angiograms (respectively: 10.9%; 12.2%; 33.6% then 28.9%) and PCIs (respectively: 0.9%; 5.6%; 16.1% then 24.4%). In the immediate post-COVID-19 period, a significant increase, uncorrelated with the natural progression, was observed for SDD diagnostic coronary angiography and ad-hoc PCI. There were no deaths or serious complications, the rate of minor complications (1.1%) and conversion to conventional hospitalisation (4.5%) were low. CONCLUSION: Provided a careful patient selection and rigorous organisation, SDD coronary angiography and PCI can safely be performed. The increase in the SDD interventional procedures, favoured by organisational (COVID-19) or economic constraints, need to be amplified.

Clinical relevance of coronary risk classification and reclassification with coronary artery calcium score in asymptomatic people living with diabetes. An observational study.

AIMS: To explore (i) in what proportion and direction coronary artery calcium (CAC) score reclassifies coronary risk in asymptomatic diabetic patients at high a priori coronary risk, and (ii) whether screening for asymptomatic myocardial ischemia / coronary stenosis only in patients at very high coronary risk - whether a priori or combined with those reclassified at very high risk according to their CAC score - has good sensitivity to detect these conditions. METHODS: We retrospectively selected 377 asymptomatic primary prevention diabetic patients at high or very high a priori coronary risk according to national guidelines. All had their CAC score measured and underwent stress myocardial scintigraphy to detect myocardial ischemia. Those identified with ischemia then had a coronary angiography to identify coronary stenoses. RESULTS: Of the selected patients, 242 and 135 patients had a high and very high a priori coronary risk, respectively. After taking into account their CAC score, the former were reclassified into three risk categories: moderate (n = 159, 66%), high (n = 38) and very high (45 patients) risk. Myocardial ischemia was identified in 35 patients and coronary stenoses in 14 of the latter. Had a stress scintigraphy been performed only in the 135 patients at very high risk a priori, 18 patients would have been detected with ischemia (sensitivity 51%), and 9 with coronary stenoses (sensitivity 64%). Had a scintigraphy also been performed on the 45 patients at very high risk after CAC-reclassification, an additional 7 and 5 patients with ischemia and coronary stenoses, respectively, would have been identified. CONCLUSION: Following national guidelines, 66% of our population of asymptomatic diabetic persons at high a priori coronary risk were reclassified into the moderate risk category, translating into less stringent goals for risk factor control. Eighteen percent were reclassified into the very high-risk category, leading to 100% detection sensitivity for patients with ischemia and coronary stenoses.

[living with our dead]. / Vivre avec nos morts.

As a young cardiologist, Dr. Guillaume Bonnet was confronted with the end of life during a significant death that occurred during a shift in cardiological intensive care. Through his testimony, we can see the importance of freeing up speech, as well as ways of thinking about preparing physicians for such situations, particularly by highlighting the role of simulation.

[Recreative drug use and cardiovascular disease]. / Consommation de drogues récréatives et pathologies cardiovasculaires.

Widely spread, and continuously increasing, recreational drug use in general population has been associated with cardiovascular events, as illustrated by clinical studies and supported by a pathophysiological rationale. Understanding the cardiovascular effects of drugs, screening, and secondary prevention are crucial components in the management of those patients in cardiology.

[The Role of the Electrocardiogram (ECG) In the Screening and Prevention of Sudden Cardiac Death in Sports]. / Die Rolle des Elektrokardiogramms (EKG) in der Prävention des plötzlichen Herztods im Sport.

The Role of the Electrocardiogram (ECG) In the Screening and Prevention of Sudden Cardiac Death in Sports Abstract: Athletes carry a higher risk for sports-related sudden cardiac death compared to the general population. The majority of these athletes suffer from an undiagnosed heart disease. Since physical activity is an essential trigger for sudden cardiac death in individuals with undiagnosed, usually hereditary, heart disease, sports can lead to sudden cardiac death in these athletes. Different heart diseases lead to sudden cardiac death at different ages during sports. The electrocardiogram (ECG) is an important screening tool to identify individuals of all ages with heart disease that are associated with sports-related sudden cardiac death. These individuals can then be treated and lives can be saved.

[Registry CARDIO-ARSIF - Database on coronary angiography and percutaneous coronary invasive performed in Île-de-France]. / Registre CARDIO-ARSIF - Base de données sur les coronarographies et angioplasties coronaires réalisées en Île-de-France.

The CARDIO-ARSIF registry has been continuously collecting comprehensive data on coronary angiography and percutaneous coronary interventions (PCI) performed in the 36 catheterization laboratories across the Île-de-France region since 2000. Over the period from 2003 to 2022, this registry has recorded information from more than 330,000 patients, encompassing more than one million procedures. Among these procedures, 58% consisted of coronary angiography, 13% were percutaneous coronary interventions (PCI), and the remaining 28% were PCI performed on an ad-hoc basis. This extensive dataset serves as a valuable resource for both qualitative and quantitative assessments of practices and the relevance of procedures in the field of coronary invasive cardiology. The results of these analyses undergo annual validation by a dedicated scientific committee and are shared with the teams of investigators. The exploitation of this data has led to scientific publications, with one notable finding being a consistent reduction in the radiation doses received by patients, regardless of the type of procedure.

[Experiencing death as a heart caregiver]. / Vivre la mort quand on est soignant du cœur.

Like physicians, cardiac paramedics are regularly confronted with death in the course of their practice. However, it would seem that they do not experience these situations in the same way. Initial training, nursing standards, and certain mechanisms such as the analysis of professional practices lead to the adoption of a particular position with patients and a specific way of dealing with the end of life and death.

[Acute coronary syndrome and cannabis use: a retrospective cohort study]. / Syndrome coronarien aigu et consommation de cannabis ; étude monocentrique rétrospective au Centre Hospitalier de Troyes.

INTRODUCTION: Acute coronary syndrome (ACS) is the usual clinical entry point for coronary heart disease. France is the European country with the highest prevalence of cannabis use and an increase in serious cardiovascular complications, including infarction, related to cannabis. The main objective was to compare the clinical and cardiological profile of patients with ACS according to exposure to cannabis use. POPULATION AND METHODS: We conducted a retrospective, single-centre, exposure-non-exposure cohort study of all adult patients (> 18 years) admitted for ACS in the ICU between January 1, 2012 and December 31, 2021 at the Centre Hospitalier de Troyes, with mention of cannabis use in the medical record. A matching was performed so that each patient identified in the exposed group was associated with a comparable unexposed patient on age, sex, period of hospitalisation and cardiovascular event typology (type of ACS and topography for ST+). RESULTS: 2745 patients admitted to the ICU and the coronary angiography room presented an ST+ or ST- ACS from 01/01/2012 to 31/12/2021 at the CHT. For 31 patients of them (1.1%), we noted cannabis consumption, which concern 7,9% of SCA ST+ aged under 50. DISCUSSION: The link between cannabis use and ACS is established, but studies concerning the place of cannabis in the ACS pathway of an ICU are few in France. Our results show the interest of developing a specific pathway focused on the needs of patients and their specificities in post ACS management.

[Levine's sign in the diagnosis of acute coronary syndrome with non-contributory electrocardiogram: About one case at the Abidjan Cardiology Institute (Ivory Coast)]. / Signe de levine dans le diagnostic du syndrome coronarien aigu avec electrocardiogramme non contributif : A propos d'un cas a l'Institut de Cardiologie d'Abidjan (Cote d'Ivoire).

Acute chest pain is usually expressed in typical language; which is sometimes assigned a particular sign. One of the signs is that of Levine, usuallytranslating a coronary involvement. This clinical case highlights a patient who is admitted for chest pain with Levine's sign and a non-contributory electrocardiogram. Biological and coronarographic explorations carried out for this purpose revealed occlusion of the proximal right coronary artery by thrombosis, successfully revascularized. This observation highlights the place of the interrogation in the assessment of any patient.

La douleur thoracique aiguë s'exprime généralement dans un langage typique; qui se voit parfois attribuer un signe particulier. Un des signes est celui de Levine, traduisant en général une atteinte coronarienne. Ce présent cas clinique met en évidence un patient qui est admis pour une douleur thoracique avec des caractères du signe de Levine et un électrocardiogramme non contributif. Les explorations biologique et coronarographique réalisées à cet effet ont permis de mettre en évidence une occlusion de l'artère coronaire droite proximale par thrombose, revascularisée avec succès.Cette observation met en lumière la place de l'interrogatoire dans l'évaluation de tout patient.

[Impact of the COVID-19 pandemic on the activities of the cardiology department of the Ignace Deen National Hospital at the Conakry University Hospital]. / Impact de la pandémie de COVID-19 sur les activités du service de cardiologie de l'hôpital national Ignace Deen du CHU de Conakry.

The new coronavirus pandemic (COVID-19) is the main global health crisis of our time and the greatest threat we have faced in this century. According to the National Health Security Agency (ANSS), which is the national body responsible for managing epidemics and pandemics, 1927 cases of COVID-19 were confirmed, 11 deaths with more than 4000 contact subjects. The objective of this study was to assess the impact of the COVID-19 pandemic on the activities of the cardiology department of the Ignace Deen National Hospital at the Conakry University Hospital. This was a descriptive retrospective study from January 2020 to April 2020, focusing on consultation and hospitalisation activities in the cardiology department of Ignace Deen National Hospital at Conakry University Hospital. The study consisted of assessing the impact of the pandemic on patient use of the service during the first weeks of the pandemic. We recorded the frequency of consultations and hospitalisations from March to April 2020, which we compared to the frequency of consultations and hospitalisations in January and February 2020. During this study from March to April 2020, we identified 130 patients in consultation against 450 patients for the two months preceding the official declaration of the pandemic in Guinea, a drop of 71.1% (320 patients). The same remark was made in hospitalisation with a drop of 75% (35 patients against 140 for the two months preceding the pandemic). At the start of the COVID-19 pandemic in Guinea, it is clear that there has been a rapid and significant drop in the effective use of the cardiology service.

[Managing STEMI before the hospital : let's identify our enemies!] / Prise en charge de l'infarctus avant l'hôpital : identifions nos ennemis !

Managing a patient with chest pain suspected to be a ST segment elevation myocardial infarction is a race against time. This management is based on a chain, like what is presented for cardiac arrest. Three phases follow one another, with potential loss of time successively attributable to the patient, the emergency physician and then the cardiologist. It would be tempting to consider that the main culprit in the event of delayed treatment is the patient. This review is the opportunity to show that it is not the case. The emergency physician, the cardiologist and their interconnection are the main providers of delay and, as such, the main enemies of myocardial reperfusion.

Unusual cause of dyspnea: Cardiac fusiform cells carcinoma.

This manuscript illustrates an unusual cause of dyspnea. Cardiac tumor are uncommon, especially fusiform cells carcinoma.

Impact of COVID-19 on the incidence of cardiac arrhythmias in implantable cardioverter defibrillator recipients followed by remote monitoring.

BACKGROUND: The coronavirus disease 2019 (COVID-19) has been a fast-growing worldwide pandemic. AIMS: We aimed to investigate the incidence of cardiac arrhythmias among a large French cohort of implantable cardioverter defibrillator recipients over the first 5 months of 2020. METHODS: Five thousand nine hundred and fifty-four implantable cardioverter defibrillator recipients were followed by remote monitoring during the COVID-19 period (from 01 January to 31 May 2020). Data were obtained from automated remote follow-up of implantable cardioverter defibrillators utilizing the Implicity® platform. For all patients, the type of arrhythmia (atrial fibrillation, ventricular tachycardia or ventricular fibrillation), the number of ventricular arrhythmia episodes and the type of implantable cardioverter defibrillator-delivered therapy were recorded. RESULTS: A total of 472 (7.9%) patients presented 4917 ventricular arrhythmia events. An increase in ventricular arrhythmia incidence was observed after the first COVID-19 case in France, and especially during weeks #10 and #11, at the time of major governmental measures, with an increase in the incidence of antitachycardia pacing delivered therapy. During the 11 weeks before the lockdown order, the curve of the percentage of live-stream television coverage of COVID-19 information matched the ventricular arrhythmia incidence. During the lockdown, the incidence of ventricular arrhythmia decreased significantly compared with baseline (0.05±0.7 vs. 0.09±1.2 episodes per patient per week, respectively; P<0.001). Importantly, no correlation was observed between ventricular arrhythmia incidence and the curve of COVID-19 incidence. No changes were observed regarding atrial fibrillation/atrial tachycardia episodes over time. CONCLUSIONS: An increase in ventricular arrhythmia incidence was observed in the 2 weeks before the lockdown order, at the time of major governmental measures. Ventricular arrhythmia incidence decreased dramatically during the lockdown.