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Objective To examine metrologic properties of near-infrared spectroscopy (NIRS) versus transcutaneous oxygen tension (TcPO 2 ) for microcirculatory assessment of vascular transtibial stumps at the stabilized period of prosthesis fitting, as a preliminary step before exploring its ability to predict stump healing, considering the previously identified limits of TcPO 2 (borderline area between 15 and 35mmHg). Design Prospective single-center observational study. Setting University-based rehabilitation center. Participants Individuals with unilateral transtibial amputation for peripheral artery disease, at the definitive stage of prosthesis fitting, able to perform a 2-minute walk test (N=30). Interventions Not applicable. Main Outcome Measures Test-retest, with the stump being evaluated in supine and inclined positions, first by NIRS (tissue saturation index [TSI], oxyhemoglobin, deoxyhemoglobin, and total hemoglobin) and second by TcPO 2 . Subjects carried out a 2-minute walk test and visual analog scales (wound healing and pain). Results Feasibility and tolerance of NIRS were satisfactory. The reliability of NIRS and TcPO 2 values was good (intraclass correlation coefficient >0.7; P <.05). No significant relation was found between NIRS and TcPO 2 . No responsiveness (inclined vs supine) was reported ( P >.05). A significant relation between TSI and the 2-minute walk test ( r >.49, P <.05) was found. Conclusions NIRS is painless, complication-free, and feasible, with good reliability. NIRS evaluates others domain than TcPO 2 that are more linked to metabolic adaptation. Its capacity to predict stump healing and tolerance to early prosthesis fitting is therefore interesting to estimate in future studies. [ABSTRACT FROM AUTHOR]

• There was no significant difference between population from Europe and population from Caribbean Sea across almost all demographic criteria, no effect of migration was observed in those two region of France • There was no significant difference on MSSS between the two French MS populations, one living in the Caribbean Sea and the other in Europe. • This study is the first comparing two region of France that highlights a sufficiently strong care system across France, allowing to absorb environmental and medical/paramedical demographic disparities for low EDSS patients. [ABSTRACT FROM AUTHOR]

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Introduction: T wave morphological changes before onset of ventricular arrhythmia are poorly known. ICD-stored intracardiac electrograms (EGM) present a unique opportunity for detecting temporal changes in repolarisation before initiation of VT/VF. Methods: 57 implanted patients with St Jude Medical ICDs (45 men, 64±12 yo, mean EF 34±15%) were prospectively enrolled. Eleven different T wave parameters were extracted from EGM (T amplitude, T peak time, T end time, T duration between baseline crossing and between points of maximal slopes, T peak to T end, maximal ascending and descending slopes, timing of points of maximal slopes and T wave area). Values of each parameter in recordings prior to VT/VF were compared to control recordings sharing comparable QRS and T wave morphology and similar heart rate in the same pts. Results: 23 VT/VF episodes (24±13 beats) and 13 baseline (25±9 beats) (ns) were analyzed in 12 pts (1,9 episode/pt). Mean heart rate was 71±17 bpm for episodes and 66±16 bpm for baseline recordings (ns). Significant differences were found in T wave amplitude, T wave maximal slopes, T peak time and timing of the T wave maximal ascending slope (although ns when corrected by the heart rate). Conclusions: T wave amplitude is higher, T wave slopes are steeper and initial parts of the T wave are earlier before ventricular arrhythmia compared to baseline. Detection of T wave changes prior to VT/VF might be useful in predicting imminent arrhythmia occurrence. Display Omitted [ABSTRACT FROM AUTHOR]

Introduction: T wave morphological changes before onset of ventricular arrhythmia are poorly known. ICD-stored intracardiac electrograms (IEGM) present a unique opportunity for detecting temporal changes in repolarisation before initiation of VT/VF. Methods: 56 implanted patients with St Jude medical ICDs (44 men, 63±12 yo, mean EF 34±15%) were prospectively enrolled. Eleven different T wave parameters were extracted from IEGM (T amplitude, T peak time, T end time, T duration between baseline crossing and between points of maximal slopes, T peak to T end, maximal ascending and descending slopes, timing of points of maximal slopes and T wave area). Averaged values of each parameter in recordings prior to VT/VF were compared to control recordings sharing comparable QRS and T wave morphology and similar heart rate in the same pts. Results: 22 VT/VF episodes (24±13 beats) and 13 baseline (25±9 beats) (ns) were analyzed in 12 pts (1,8 episode/ pt). Mean heart rate was 71±17 bpm for episodes and 66±16 bpm for baseline recordings (ns). Significant differences were found in T wave amplitude and slopes. Durations and timings of the different parts of the T wave did not significantly vary. Conclusions: Detection of T wave changes prior to VT/VF might be useful in predicting imminent arrhythmia occurrence. T wave amplitude is higher and T wave slopes are steeper before ventricular arrhythmia compared to baseline, without significant shortening of different repolarisation times. Display Omitted [Copyright &y& Elsevier]

Objective Atrial fibrillation (AF) is a common arrhythmia associated with increased risk of thromboembolic events or other complications. The French randomized, multicenter, SETAM trial assessed the impact of the home monitoring (HM) technology on detection and treatment of supra-ventricular arrhythmia (SVA). Methods Patients (pts) implanted with a dual chamber pacemaker were enrolled in the study at hospital discharge if they had a sinusal rhythm at enrollment, no antiarrhythmic, anticoagulant or dual-antiplatelet therapy, and if they had a CHA2DS2-VASc score of 2 or more. The pts were randomly assigned to an active group (Act Gp), followed by Biotronik HM, or a control group (Cont Gp) without HM surveillance. The time from implantation to the first SVA-related intervention was compared between the 2 groups (primary endpoint). Results A total of 595 pts (mean age = 79±8 y.o, 63% male, mean CHA2DS2-VASc score = 3.7±1.2) were followed during 12.8±3.3Mo. The most prevalent co-morbidities were hypertension (82% pts), diabetes (29%) and vascular disease (24%). Implantation indications were atrio-ventricular blocks in 77% of pts, sinus node disease in 20% and others in 3%.The global SVA incidence was 25% (29% in the Act Gp vs 22% in the Cont Gp, p=ns).A therapy (drugs or ablation) was instituted for 49/291 pts (17%) in the Act Gp vs 43/304 pts (14%) in the Cont Gp (p=ns). The median time from implantation to the first therapy for SVA was 114 [44; 241] days in the Act Gp vs 224 [67; 366] days in the Cont Gp, representing a median gain of 110-days in SVA management (50% reduction, p=0.01). Over these 92 pts, 54 had AF (59%) and 38 had atrial flutter or tachyarrhythmia (41%). Anticoagulation was initiated in 80% of pts and antiarrhythmic drugs in 55%. Conclusion The SETAM study demonstrated that HM allows earlier detection and treatment of SVA in pacemaker pts. The next step is to report how early detection of SVA with HM can possibly improve the patients clinical outcome. [ABSTRACT FROM AUTHOR]

Introduction We developed the usage of a simple tunnelling method from controlateral access to the device in case of homolatéral subclavian access failure when an additional lead is needed. Goal of the study long term evaluation of feasibility and safety of this tunneling strategy. Method From September 1998 to September 2011, a coronary sinus (CS) lead was implanted through controlateral access after failure of homolateral to the device implantation in 31 consecutive patients (19 males 72+/- 8 yo). Indications were thrombosis 14 and failure to catheterize CS 17. All these patients were already implanted with a single or double chamber pacemaker or internal cardiac defibrillator and were referred for upgrading to biventricular pacing. The packaging sheath of a simple conventional catheter (plastimed) was introduced from one side to the other under local anesthesia after scissors dissection under local anesthesia. Tunneling of coronary sinus lead was performed through the sheath which was then withdrawed. Results Success tunneling procédure rate was 100%. Tunelling time was 3+/-2 mn. Complications related to the procedure: 2 cases of xylocaine overdose needed temporary ventilation assistance at beginning of experience. 1 early dislodgment needed replacement, 2 cases of early battery wear because of low impédance of the cs lead. No hematoma, no acute or late pain complain, no lead infection were reported. Conclusion Controlateral implantation through a simple packaging sheath is a simple and safe option in case of homolateral access failure in upgrading indications. [ABSTRACT FROM AUTHOR]

Background: The French study OBEPI in 2006 showed that around 1 person out of 3 is overweight (BMI>25) or obese (BMI>30). In Coronary Rehabilitation (CR) in Joigny (France), we observed that more than 2 persons out of 3 are overweight or obese (n=110). The objectives of CR are the improvements of life expectancy, the quality of life. But in practice, how does the body composition evolve? Methods: CR consists of 20 sessions from 9 am till 4 pm, 3 times a week. At first and after CR, patients performed a symptom limited cardiopulmonary test and a 6 minutes walking test: the bioelectrical impedance was done on a Tanita BC 418. Every session includes physical training (ergocycle, walk, strength training: 45 min each), therapeutic education, in particular dietary (information and therapeutic cooking) minimum once a week. Results: The patient''s physical performances are improved (P<0,01): VO2 peak (+0,15L/min) and distance covered during 6MWT (+86m). The weight is stable but we observe that the fat mass (FM) decreases of 717g (P<0,01) for an increase of the lean body mass (LBM) of 812g (P<0,01). Conclusion: Multidisciplinary CR allows an improvement of physical performances. The remodelling of body composition results in an increase of LBM and a decrease of FM. It seems that an estimation of the body composition is useful in order to quantize exactly the weight evolution and these components during a CR. [Copyright &y& Elsevier]

Introduction: T wave alternans (TWA) has been demonstrated as a strong predictor of mortality and ventricular arrhythmias. ICD-stored intracardiac electrograms (IEGM) present a unique opportunity for detecting temporal relationship between the occurrence of TWA and spontaneous arrhythmia. The aim of the ETWAS study was to assess the feasibility of detection of TWA preceding the onset of VT/VF in IEGM. Methods: 56 implanted patients with St Jude medical ICDs (44 men, 63±12 yo, mean EF 34±15%) were prospectively enrolled and monitored for one year. Thirteen different T wave parameters were extracted from IEGM (T amplitude, T peak time, Bazett and Hodges corrected T peak time, T end time, T duration between baseline crossing and between points of maximal slopes, T peak to T end, maximal ascending and descending slopes, timing of points of maximal slopes and T wave area). Successive beat by beat differences in each parameter in recordings prior to VT/VF were compared to control recordings in the same pts. TWA was considered if beat by beat variations for at least one parameter was significantly higher than baseline with a p value < 0,01. Results: 22 VT/VF episodes (24±13 beats, 71±17 bpm) and 13 baseline (25±9 beats, 72±18) (ns) were analyzed in 12 pts (1,8 episode/ pt). TWA was present before VT/VF onset in 13 episodes (7 pts) with 1 to 9 differing parameters (3±2). Significant beat by beat differences before VT/VF onset were observed in amplitude, timing, slopes, area and duration of the T wave. Amplitude of the beat by beat variations was 3 to10 larger in episodes than in baseline. Paired and unpaired comparisons of the averaged values of beat by beat variations however did not reveal significant difference between baseline and episodes, except for T wave amplitude (0,07 +/– 0,006 vs 0,14 +/– 0,03 mV, p=0.03 paired and 0,04 unpaired). Conclusions: Detection of TWA prior to VT/VF might be useful in predicting imminent arrhythmia occurrence. TWA can be detected before VT/VF onset in more than half of episodes using a simple time-domain technique and multiple T wave measurements. T wave amplitude seems the most discriminant parameter. [Copyright &y& Elsevier]

Aims: To assess whether abnormal dobutamine stress echocardiography (DSE) can be a consequence of dobutamine-induced coronary spasm in patients with angiographically documented vasospastic coronary arteries. Methods: Between January 2004 and April 2008, we prospectively evaluated all patients with known or suspected coronary artery disease (CAD) referred to the echocardiography laboratory for dobutamine stress tests (6061 examinations). Those with abnormal DSE underwent coronary angiogram with a systematic methylergometrine intracoronary injection in the case of absence of significant coronary stenosis or spontaneous occlusive coronary spasm. Patients who had spontaneous occlusive coronary spasm or positive methylergometrine test, but no significant stenoses, were ultimately included in this study. Results: About 581 patients had abnormal DSE, among them only 20 (3.4%) fulfilled the inclusion criteria. There were 15 males and 5 females, and mean age was 64.35 years (range 52-85); 8 patients had a known history of CAD and all of them had at least two established cardiovascular risk factors. The culprit vessel was the left anterior descending artery in 10 cases (50%), right coronary artery in 8 cases (40%), and left circumflex in 2 cases (10%). There was a systematic correspondence between the culprit arteries and dobutamine-induced wall motion abnormality territories. No complications occurred during examination or during the provocation test. All the patients were discharged with a calcium channel blocker and were doing well after 13 months of mean follow-up. Conclusion: Coronary artery spasm can be induced at DSE, but is a rare finding; it could, though, be clinically relevant as it may partly explain some erroneously labelled ‘false-positive’ examinations. Methylergometrine provocation test is a safe and advisable approach in such situations. [Copyright &y& Elsevier]