Position paper on sustainability in cardiac pacing and electrophysiology from the Working Group of Cardiac Pacing and Electrophysiology of the French Society of Cardiology.

Sustainability in healthcare, particularly within the domain of cardiac electrophysiology, assumes paramount importance for the near future. The escalating environmental constraints encountered necessitate a proactive approach. This position paper aims to raise awareness among physicians, spark critical inquiry and identify potential solutions to enhance the sustainability of our practice. Reprocessing of single-use medical devices has emerged as a potential solution to mitigate the environmental impact of electrophysiology procedures, while also offering economic advantages. However, reprocessing remains unauthorized in certain countries. In regions where it is possible, stringent regulatory standards must be adhered to, to ensure patient safety. It is essential that healthcare professionals, policymakers and manufacturers collaborate to drive innovation, explore sustainable practices and ensure that patient care remains uncompromised in the face of environmental challenges. Ambitious national/international programmes of disease prevention should be the cornerstone of the strategy. It is equally vital to implement immediate actions, as delineated in this position paper, to bring about tangible change quickly.

To what extent does freezing impact the mid-infrared signature of urine? Case of patients attending urology department.

Urine is a very interesting and attractive biofluid for biomarker discovery and medical diagnosis research due to its non-invasiveness collection and richness of potential biomarkers. Fourier-Transform Infrared (FTIR) spectroscopy applied on urine samples is a promising tool that could be used as a screening method for various diseases. However, during method development, frozen urine is more accessible, especially for inter-laboratory studies, whereas in routine application fresh urine is more convenient. Here, the objective of our work is to evaluate the freezing impact on mid-infrared signature of urine samples. Therefore, both fresh and frozen urine samples from twenty patients were analysed in a dried form. These samples were collected from patients consulting for cystoscopy examination. Simultaneously, centrifugation was also conducted on 10 of all included patients. Principal component analysis (PCA) revealed that patient inter-variabilities are higher than variability due to the freezing step. Then, Euclidean distance between fresh and frozen urine of each patient highlighted that the impact of freezing is different from one patient to another. Adding the centrifugation step slightly minimized intra-patient variability compared to not centrifugated samples. This study contributes to define experimental conditions for urine analysis development for translational application in biomedical field.

Information provision and follow-up of French patients with implantable cardioverter-defibrillators: The APODEC survey.

BACKGROUND: Implantable cardioverter-defibrillators reduce mortality, but the electric shocks delivered can impact the patient's quality of life. Patient education is an efficient way to reduce the stress related to both the device and the disease. AIMS: We assessed the evolution of knowledge and satisfaction of implantable cardioverter-defibrillator recipients regarding their cardiac disease, implantable cardioverter-defibrillator implantation, follow-up complications, remote monitoring and daily life recommendations. Quality of life, implantable cardioverter-defibrillator-related stress levels and remote monitoring benefits were also evaluated. METHODS: A self-administered questionnaire of 43 items was published on the French Association of Cardiac Electrical Device Wearers (APODEC) website and sent to registered patients. RESULTS: Overall, 330 patients completed the survey. Physicians were the patients' principal information source regarding their cardiac disease (86.7%) and implantable cardioverter-defibrillator (93.3%), and 90% looked for further information after the procedure, mainly on websites (78.8%). More than half of the patients were not sufficiently informed about implantable cardioverter-defibrillators before implantation (61.2%). In the patients' opinion, the best sources of further information were their physician (81.8%), patient associations (63.6%) and the Internet (45.8%). Although patient knowledge increased during follow-up, their knowledge could be improved regarding daily life with an implantable cardioverter-defibrillator (52.1%), remote monitoring (34.2%) and their cardiac disease (32.1%). Remote monitoring follow-up was used by 92.1% of patients and mostly improved their peace of mind (67.8%). Implantable cardioverter-defibrillator shocks were associated with major stress for patients receiving them (46.6%). CONCLUSION: These findings highlight the lack of information provided to implantable cardioverter-defibrillator recipients before implantation, a concerning issue to be addressed in the near future.

Leucine-Based Pseudo-Proteins (LPPs) as Promising Biomaterials: A Study of Cell-Supporting Properties.

Scaffold-based systems have become essential in biomedical research, providing the possibility of building in vitro models that can better mimic tissue/organic physiology. A relatively new family of biomimetics-pseudo-proteins (PPs)-can therefore be considered especially promising in this context. Three different artificial leucine-based LPP films were tested in vitro as potential scaffolding materials. In vitro experiments were performed using two types of cells: primary mouse skin fibroblasts and a murine monocyte/macrophages cell line, RAW264.7. Cell adhesion and cell spreading were evaluated according to morphological parameters via scanning electron microscopy (SEM), and they were assessed according to actin cytoskeleton distribution, which was studied via confocal laser microscopy. Cell proliferation was evaluated via an MTT assay. Cell migration was studied using time-lapse microscopy. SEM images for both types of cells demonstrated prominent adhesion and perfect cell spreading on all three LPPs. Analyses of actin cytoskeleton organization revealed a high number of focal adhesions and prominent motility-associated structures. A certain stimulation of cell proliferation was detected in the cases of all three LPPs, and two of them promoted macrophage migration. Overall, our data suggest that the LPPs used in the study can be considered potential cell-friendly scaffolding materials.

Searching for atrial fibrillation post stroke: is it time for digital devices?

The detection of atrial fibrillation (AF) in patients with cryptogenic stroke (CS) is an essential part of management to limit the risk of recurrence. However, in practice, not all patients who need AF screening are screened, or are screened with significant delays. The disparities of access to examinations, their costs as well as the increasing workload require an evolution of practices both in terms of organization and the type of equipment used. The ubiquity and ease of use of digital devices, together with their evaluation in large population and their expected lower cost, make them attractive as potential alternatives to current equipment at all stages of patient management. However, reliability and accuracy of each digital device for the detection of paroxysmal AF in CS patients should be established before consideration for inclusion in clinical practice. The aim of this short analysis is therefore to review the current practical issues for AF detection in post stroke patients, the potential benefits and issues using digital devices in stroke patients and to position the different digital devices as alternative to standard equipment at each stage of stroke patient pathway. This may help to design future studies for the evaluation of these devices in this context. Under this condition, the time for digital devices to detect AF after stroke seems very close.

Deep learning for the prediction of the chemotherapy response of metastatic colorectal cancer: comparing and combining H&E staining histopathology and infrared spectral histopathology.

Colorectal cancer is a global public health problem with one of the highest death rates. It is the second most deadly type of cancer and the third most frequently diagnosed in the world. The present study focused on metastatic colorectal cancer (mCRC) patients who had been treated with chemotherapy-based regimen for which it remains uncertainty about the efficacy for all eligible patients. This is a major problem, as it is not yet possible to test different therapies in view of the consequences on the health of the patients and the risk of progression. Here, we propose a method to predict the efficacy of an anticancer treatment in an individualized way, using a deep learning model constructed on the retrospective analysis of the primary tumor of several patients. Histological sections from tumors were imaged by standard hematoxylin and eosin (HE) staining and infrared spectroscopy (IR). Images obtained were then processed by a convolutional neural network (CNN) to extract features and correlate them with the subsequent progression-free survival (PFS) of each patient. Separately, HE and IR imaging resulted in a PFS prediction with an error of 6.6 and 6.3 months respectively (28% and 26% of the average PFS). Combining both modalities allowed to decrease the error to 5.0 months (21%). The inflammatory state of the stroma seemed to be one of the main features detected by the CNN. Our pilot study suggests that multimodal imaging analyzed with deep learning methods allow to give an indication of the effectiveness of a treatment when choosing.

Survey on the paramedical role in the remote monitoring of cardiac implantable electronic devices in France.

Remote monitoring of cardiac implantable electronic devices (CIEDs) has become an expansive priority in many European countries, with nurses playing a central role in it. In France, a national survey for paramedics was set up to assess the organization of remote monitoring in the different institutions and to determine the paramedical role. A self-administered questionnaire (supplementary material), developed and validated by the College of Paramedics in partnership with the Working Group of Pacing and Electrophysiology of the French Society of Cardiology (SFC).

Dynamic changes in nocturnal heart rate predict short-term cardiovascular events in patients using the wearable cardioverter-defibrillator: from the WEARIT-France cohort study.

AIMS: While elevated resting heart rate measured at a single point of time has been associated with cardiovascular outcomes, utility of continuous monitoring of nocturnal heart rate (NHR) has never been evaluated. We hypothesized that dynamic NHR changes may predict, at short term, impending cardiovascular events in patients equipped with a wearable cardioverter-defibrillator (WCD). METHODS AND RESULTS: The WEARIT-France prospective cohort study enrolled heart failure patients with WCD between 2014 and 2018. Night-time was defined as midnight to 7 a.m. NHR initial trajectories were classified into four categories based on mean NHR in the first week (High/Low) and NHR evolution over the second week (Up/Down) of WCD use. The primary endpoint was a composite of cardiovascular death and heart failure hospitalization. A total of 1013 [61 (interquartile range, IQR 53-68) years, 16% women, left ventricular ejection fraction 26% (IQR 22-30)] were included. During a median WCD wear duration of 68 (IQR 44-90) days, 58 patients (6%) experienced 69 events. After considering potential confounders, High-Up NHR trajectory was significantly associated with the primary endpoint compared to Low-Down [adjusted hazard ratio (HR) 6.08, 95% confidence interval (CI) 2.56-14.45, P < 0.001]. Additionally, a rise of >5 bpm in weekly average NHR from the preceding week was associated with 2.5 higher composite event risk (HR 2.51, 95% CI 1.22-5.18, P = 0.012) as well as total mortality (HR 11.21, 95% CI 3.55-35.37, P < 0.001) and cardiovascular hospitalization (HR 2.70, 95% CI 1.51-4.82, P < 0.001). CONCLUSION: Dynamic monitoring of NHR may allow timely identification of impending cardiovascular events, with the potential for 'pre-emptive' action. REGISTRATION NUMBER: Clinical Trials.gov Identifier: NCT03319160.

Trajectory Inference for Unraveling Dynamic Biological Processes from Raman Spectral Data.

Cell heterogeneity is a crucial parameter for understanding the complexity of numerous biomedical issues. Trajectory inference-based approaches are recent tools developed for single-cell transcriptomics (scRNA-seq) data analysis. They aim to reconstruct evolving pathways from the variety of cell states that coexist simultaneously in a cell population. We propose to expand this concept to Raman spectroscopy, a label-free modality that probes the global molecular nature of a sample, by investigating the dynamics of adipocyte differentiation.

Identification of circulating biomarkers of Crohn's disease and spondyloarthritis using Fourier transform infrared spectroscopy.

Crohn's disease (CD) and spondyloarthritis (SpA) are two inflammatory diseases sharing many common features (genetic polymorphism, armamentarium). Both diseases lack diagnostic markers of certainty. While the diagnosis of CD is made by a combination of clinical, and biological criteria, the diagnosis of SpA may take several years to be confirmed. Based on the hypothesis that CD and SpA alter the biochemical profile of plasma, the objective of this study was to evaluate the analytical capability of Fourier transform infrared spectroscopy (FTIR) in identifying spectral biomarkers. Plasma from 104 patients was analyzed. After data processing of the spectra by Extended Multiplicative Signal Correction and linear discriminant analysis, we demonstrated that it was possible to distinguish CD and SpA from controls with an accuracy of 97% and 85% respectively. Spectral differences were mainly associated with proteins and lipids. This study showed that FTIR analysis is efficient to identify plasma biosignatures specific to CD or SpA.

Unsupervised Feature Selection by a Genetic Algorithm for Mid-Infrared Spectral Data.

Dimensional reduction of highly multidimensional datasets such as those acquired by Fourier transform infrared spectroscopy (FTIR) is a critical step in the data analysis workflow. To achieve this goal, numerous feature selection methods have been developed and applied in a supervised context, i.e., using a priori knowledge about data usually in the form of labels for classification or quantitative values for regression. For this, genetic algorithms have been largely exploited due to their flexibility and global optimization principle. However, few applications in an unsupervised context have been reported in infrared spectroscopy. The aim of this article is to propose a new unsupervised feature selection method based on a genetic algorithm using a validity index computed from KMeans partitions as a fitness function. Evaluated on a simulated dataset and validated and tested on three real-world infrared spectroscopic datasets, our developed algorithm is able to find the spectral descriptors improving clustering accuracy and simplifying the spectral interpretation of results.

New approach for hair keratin characterization: Use of the confocal Raman spectroscopy to assess the effect of thermal stress on human hair fibre.

OBJECTIVE: The objective of our research was to investigate the heat-protecting effect of a product ex vivo and in vivo on human hair fibres. METHODS: A preparatory study was carried out in order to determine an optimal threshold of thermal stress. For this, the structure of cross-sections of the hair fibre was observed by optical microscopy. Then, Scanning Electron Microscopy (SEM) and Confocal Raman Spectroscopy (CRS) were applied to analyse ex vivo and in vivo morphological and molecular damage in hair structure after heat stress. Finally, in vivo tests were used to collect consumer perception. RESULTS: The preparatory study enabled us to determine an optimal stress threshold of 10 heating cycle for SEM and 5 heating cycle for CRS. Based on spectral hierarchical classification using Ward's clustering algorithm, the ex vivo Raman results show that the spectral signature of the hair treated and heated is very close to the negative control. This shows that the product preserves the keratin structure after thermal stress. These results were also confirmed by an in vivo Raman analysis performed on hair samples from 5 donors. In concordance with Raman results, SEM shows that treated hair presents lesser "bubbles" and "crackling" on the hair surface. Finally, the in vivo studies proved that hair was more protected from heat. CONCLUSION: The authors concluded that the product shows protective properties with respect to morphological and molecular heat damage. We also demonstrate that the product promotes the α-helix keratin conformation and preserves the S-S disulfide bands.

OBJECTIF: L'objectif de notre étude est d'évaluer ex vivo et in vivo l'effet thermoprotecteur d'un produit sur les fibres capillaires humaines. MÉTHODES: Une étude préparatoire a été réalisée afin de déterminer un seuil optimal du stress thermique. Pour cela, la structure des coupes transversales des cheveux a été observée par microscopie optique. Ensuite, la microscopie électronique à balayage (MEB) et la spectroscopie confocale Raman (SCR) ont été appliquées pour analyser les dommages morphologiques et moléculaires (ex vivo et in vivo) de la structure du cheveu après un stress thermique. Enfin, des tests in vivo ont été réalisés pour recueillir la perception des consommateurs. RÉSULTATS: L'étude préparatoire nous a permis de déterminer un seuil de stress thermique optimal correspondant à 10 cycles de chauffage pour la MEB et 5 cycles de chauffage pour la SCR. Basés sur une classification hiérarchique utilisant l'algorithme de Ward, les résultats Raman « ex vivo ¼ montrent que la signature spectrale des cheveux traités et chauffés est très proche du témoin négatif. Cela montre que le produit préserve la structure de la kératine après un stress thermique. Ces résultats ont également été confirmés par une analyse Raman « in vivo ¼ réalisée sur des échantillons de cheveux de 5 donneurs. En concordance avec les résultats Raman, la MEB montre que les cheveux traités présentent moins de « bulles ¼ et de « craquelures ¼ à la surface des cheveux. Enfin, l'étude in vivo a prouvé que les cheveux sont mieux protégés de la chaleur. CONCLUSION: Les auteurs ont conclu que le produit présente des propriétés protectrices vis-à-vis des dommages thermiques morphologiques et moléculaires. Nous avons démontré également que le produit favorise la conformation de la kératine en hélice-α et préserve les bandes disulfures S-S.

Feasibility of leadless left ventricular septal pacing with the WiSE-CRT system to target the left bundle branch area: A porcine model and multicenter patient experience.

BACKGROUND: The WiSE-CRT system delivers leadless endocardial left ventricular (LV) pacing to achieve cardiac resynchronization therapy. The electrode is conventionally placed on the lateral wall, but implanting on the LV septum may have advantages, including capture of the left bundle branch, and improved battery longevity owing to reduced distance from the transmitter. OBJECTIVE: The purpose of this study was to assess the feasibility of leadless LV septal pacing via the WiSE-CRT system. METHODS: Two pigs underwent electrode implantation on the LV septum with subsequent anatomical and histological examination. Eight patients underwent implantation of the WiSE-CRT system with deployment of the electrode on the LV septum via an interatrial transseptal approach. RESULTS: Deployment of the electrode on the LV septum was successful in both animals. Histological examination demonstrated electrode tines in close proximity to Purkinje tissue. WiSE-CRT implantation with an LV septal electrode was successful in all patients. Biventricular capture was confirmed, with a significant reduction in QRS duration (187.1 ± 33.8 ms vs 149.5 ± 15.7 ms; P = .009). Temporary LV pacing achieved further QRS reduction (139.8 ± 12.4 ms), and in 4 patients the peak LV activation time in lead V5/V6 was <90 ms, suggesting left bundle branch capture. At early follow-up, the median LV pacing percentage was 98.5% and 5 patients (62.5%) improved symptomatically. The transmitter-to-electrode distance was lower than the distance to the lateral wall during acoustic window screening (8.8 ± 1.6 cm vs 11.9 ± 1.5 cm; P = .002). CONCLUSION: Leadless LV septal pacing with the WiSE-CRT system to target the left bundle branch appears feasible. Further study is required to assess the efficacy and safety of this technique.

Lack of early etiologic investigations in young sudden cardiac death.

BACKGROUND: Since majority of sudden cardiac arrest (SCA) victims die in the intensive care unit (ICU), early etiologic investigations may improve understanding of SCA and targeted prevention. METHODS: In this prospective, population-based registry all SCA admitted alive across the 48 hospitals of the Paris area were enrolled. We investigated the extent of early etiologic work-up among young SCD cases (<45 years) eventually dying within the ICU. RESULTS: From May 2011 to May 2018, 4,314 SCA patients were admitted alive. Among them, 3,044 died in ICU, including 484 (15.9%) young patients. SCA etiology was established in 233 (48.1%) and remained unexplained in 251 (51.9%). Among unexplained (compared to explained) cases, coronary angiography (17.9 vs. 49.4%, P < 0.001), computed tomography scan (24.7 vs. 46.8%, P < 0.001) and trans-thoracic echocardiography (31.1 vs. 56.7%, P < 0.001) were less frequently performed. Only 22 (8.8%) patients with unexplained SCD underwent all three investigations. SCDs with unexplained status decreased significantly over the 7 years of the study period (from 62.9 to 35.2%, P = 0.005). While specialized TTE and CT scan performances have increased significantly, performance of early coronary angiography did not change. Autopsy, genetic analysis and family screening were performed in only 48 (9.9%), 5 (1.0%) and 14 cases (2.9%) respectively. CONCLUSIONS: More than half of young SCD dying in ICU remained etiologically unexplained; this was associated with a lack of early investigations. Improving early diagnosis may enhance both SCA understanding and prevention, including for relatives. Failure to identify familial conditions may result in other preventable deaths within these families.

Prospective evolution of cardiac arrhythmia care: 2030 vision.

Cardiovascular diseases, which are the leading global cause of death, should increase by 40% by 2030, reaching close to 24 million deaths worldwide. Atrial fibrillation is the most common heart rhythm disorder, ahead of conduction disturbances and ventricular arrhythmias. Studies estimate that 7.6 million people aged>65 years in the European Union had atrial fibrillation in 2016, and this figure is predicted to increase by 89% to 14.4 million by 2060. Recent innovations in cardiac arrhythmia care, such as cardiac device miniaturization and smart devices, might revolutionize the future of patient care. Yet, the level of adoption of these breakthroughs will depend on their acceptability by patients and healthcare professionals, and on the pace of transformation of the French healthcare system (encouraged by "Ma Santé 2022"). In this article, we detail the major trends that could impact patients with heart rhythm disorders and their healthcare professionals by 2030. Eight major trends and their associated effects on patient care and healthcare professionals' practices were discussed: technical evolution of cardiac devices; digitalization of the healthcare system, and telecardiology; the rise of smart devices; the rise of "big data" and artificial intelligence; patient empowerment; evolution of healthcare; healthcare transformation with "Ma Santé 2022"; and new funding models. These "multidimensional" changes give us room in this study to outline two scenarios for the evolution of care of patients with heart rhythm disorders in the near future.

Healthcare costs in implantable cardioverter-defibrillator recipients: A real-life cohort study on 19,408 patients from the French national healthcare database.

BACKGROUND: The aim is to report healthcare costs in a nationwide cohort of patients with an implantable cardioverter defibrillator (ICD). METHODS: This real-life longitudinal retrospective cohort study was based on the French National Health Data System and enrolled all adult patients from the general health insurance scheme implanted with an ICD between 2008 and 2011, and followed them until 2018. RESULTS: Overall, 19,408 patients were included (mean age 63.8, SD 12.4 years, 81.6% males), with cardiac resynchronization therapy (CRTD), single-chamber, and dual-chamber ICD in 42.5%, 29.8%, 27.7% of patients, respectively. After a mean follow-up of 6.6 SD 3.3 years, 9514 patients (49.0%) died, and 8678 patients (44.7%) had their ICD replaced. The total healthcare cost (all diseases and injuries combined) was €15,893/patient-year, of which 32% were estimated to be ICD-related. These ICD-related costs were: the implantation hospital stay (representing 59% of the ICD-related costs), ICD replacement (22%), complications' management (11%), and follow-up (9%). Some health events (e.g., a complication during ICD replacement) were counted in two categories, hence the sum of the proportions is >100%. Being under 55 vs. above 75 years old, being treated for hypertension vs. not treated, and receiving a CRT-D vs. a single-chamber ICD each increased the mean total ICD-related cost per patient by approximately 20%; ICD replacement vs. no replacement increased it by 71%. CONCLUSIONS: Almost two thirds of the total ICD patients' healthcare costs remained not ICD-related. Advancing the understanding of direct and indirect costs may help improving cost-effectiveness of patients' care pathway.