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Digital health is currently booming, providing major innovations, particularly in terms of changing the practices of the stakeholders in the healthcare system as a whole. It allows our healthcare system to draw on new synergies between independent, hospital and medico-social professionals, as well as on high-performance digital tools for the benefit of all, users, patients and professionals. These tools, or digital solutions, have a strong potential to improve the healthcare system but also a strong potential for economic development. In this respect, the great diversity of existing and future digital solutions, as well as their vast fields of application, are prompting public and private stakeholders in the sector to question their integration into our healthcare system. The resulting challenges concern the identification of the targets they are intended for, the values they embody and, as a result, the methods of funding and evaluation. At a time when the first reimbursement terms for digital solutions are taking shape in the context of the Social Security Financing Bill for 2022, the roundtable wished to propose 8 recommendations to help structure exchanges between the various stakeholders and initiate avenues of work around the integration of digital solutions into the healthcare system. The main orientations are based on the proposal of a common and transparent reflection methodology around the technical scope of these solutions, the values they bring and the funding mechanisms. Other work will be necessary beyond the points addressed by the round table in order to go into greater depth on certain themes such as the adaptation of existing funding methods to the momentum and specificities of digital technology or the development of research work on the evaluation of the value claimed by these digital solutions.

The role of pulmonary veins (PVs) in persistent atrial fibrillation (AF) perpetuation appears less important than in paroxysmal AF. Electrogram-based substrate ablation is not widely performed as a stand-alone strategy.To evaluate PV activity in AF perpetuation and efficacy of our patient-tailored ablation strategy (electrogram-based substrate ablation with or without pulmonary vein isolation [PVI]).One hundred twenty-one patients with paroxysmal (n = 19; 15.7%), persistent (n = 77; 63.6%), or long-standing persistent (n = 25; 20.7%) AF underwent electrogram-based substrate ablation with AF termination end point: sinus rhythm or atrial tachycardia conversion. Before ablation, we classified PVs as "passive" if silent PV or if PV cycle length is greater than left atrial appendage cycle length. No PVI was performed in such cases.Passive PVs were observed in 52 of 121 patients (paroxysmal AF = 0%, persistent AF = 40%, and long-standing persistent AF = 76%; P.0001]). Substrate ablation terminated AF in 95.6% (sinus rhythm conversion in 80.2%). Compared with patients with active PVs, patients with passive PVs had longer AF sustained duration (19.1 ± 29.7 months vs 4.9 ± 11.1 months; P.0001), larger left atrial diameter (46.9 ± 7.3 mm vs 41.9 ± 6.0 mm; P = .0014), lower left ventricular ejection fraction (45.4% ± 13.5% vs 55.1% ± 9.4%; P.0001), and more often structural heart disease (57% vs 33%; P = .02). After a follow-up of 20.39 ± 11.23 months (1.6 procedures per patient), 82% were arrhythmia free with this strategy.PV activity during AF decreases with AF chronicity, left atrial dilatation, and left ventricular ejection fraction. Our patient-tailored ablation strategy without systematic PVI provides good results.

Implantable cardiac defibrillators along with telecardiology services provide improvements in health care delivery and clinical outcomes in the field of heart failure. This implies a shift from strictly device-centered follow-up to perspectives centered on the patient. In the AKENATON project, we have designed a formal ontology that supports integration of clinical data extracted from patient records with information transmitted by implantable cardiac devices, and offers reasoning capabilities to classify the alerts.

Goal To evaluate routine Remote Monitoring (RM) of Cardiovascular Implantable Device (CID). Method A multiple choice questionnaire was e-mailed to 100 French physicians Implanters of CID in November 2017. Results A total of 73 answers were obtained (73%). Seventy five percent work in a public center, twenty three percent in a private center. The rate of Internal Cardiac Defibrillator implantation (ICD)/year per center is > 100 for 63%, 50–100 for 24,7%, 1000 (9.6%), 500–1000 (27.4%), 200–500 (41.1%), Conclusion Remote monitoring of CID is a current practice in France especially for ICD follow up. Collaboration with paramedical staff is partial. Patients are informed but not systematically. Data are archived but partially. Absence of funding may explain incomplete and heterogeneous RM activity in France.

Background Inappropriate shocks (IS) are a major side effect of implantable cardioverter defibrillators (ICD). Remote monitoring (RM) may reduce inappropriate diagnoses (ID) and subsequent inappropriate therapies (IT). Purpose The purpose of THORN study was to determine the ability of ICD RM to early identify ID of ventricular arrhythmias and prompt physician reaction, in order to reduce the risk of recurrent IT. Methods THORN is an observational multicenter study of RM ICD patients, separated in a retrospective cohort (R), issued from a large RM database collected since 2007 by Biotronik SE & Co.KG and a prospective cohort (P) of patients implanted since 2012. The primary objective was to determine: 1/in the retrospective cohort, the relative proportion of patients experiencing at least one IT during a 15-month follow-up period, and, 2/in the prospective cohort, the medical reaction time (MRT) and ID recurrence after an initial ID. Results A total of 1891 patients (R: 1379, P: 512), implanted with a CRT-D (28.1%) or conventional ICD, (single chamber: 45.1%; dual chamber: 26.8%) were enrolled (83.6% men, 62.9 ± 12.8 y), 31.8% in primary prevention. During 13.7 ± 3.5 months of follow-up, 8.6% (R: 9.2%, P: 6.9%, P = 0.05) of the patients experienced at least one ID, of whom, 75.3% suffered at least one IT (R: 74%, P: 80%, P = NS) and 35.8% at least one IS. The median MRT was 9 days (0 to 145 days). It was 4 times longer for ID due to supraventricular tachyarrhythmias (16 days) compared to those due to abnormal sensing (4 days) (P = 0.04). ID recurrence occurred in 37% of ID patients, with a substantial part (25.7%) within the MRT. Among the 6.5% of patients experiencing at least one IT, 36.1% had an IT recurrence. Conclusions The rate of patients experiencing ID/IT and recurrences seems to decrease over time. Though RM is intended to take action earlier, the MRT is sometimes long and could be reduced as ID/IT recurrences are not infrequent within the MRT period.