First inappropriate implantable cardioverter defibrillator therapy is often due to inaccurate device programming: analysis of the French OPERA registry

AIMS:Inappropriate therapy delivered by implantable cardioverter defibrillators (ICDs) remains a challenge. The OPERA registry measured the times to, and studied the determinants of, first appropriate (FAT) and inappropriate (FIT) therapies delivered by single-, dual- and triple-chamber [cardiac resynchronization therapy defibrillator (CRT-D)] ICD. METHODS AND RESULTS: We entered 636 patients (mean age = 62.0 ± 13.5 years; 88% men) in the registry, of whom 251 received single-, 238 dual-, and 147 triple-chamber ICD, for primary (30.5%) or secondary (69.5%) indications. We measured times to FAT and FIT as a function of multiple clinical characteristics, examined the effects of various algorithm components on the likelihood of FAT and FIT delivery, and searched for predictors of FAT and FIT. Over 22.8 ± 8.8 months of observation, 184 patients (28.9%) received FAT and 70 (11.0%) received FIT. Ventricular tachycardia (VT) was the trigger of 88% of FAT, and supraventricular tachycardia was the trigger of 91% of FIT. The median times to FIT (90 days; range 49-258) and FAT (171 days; 50-363) were similar. The rate of FAT was higher (P <0.001) in patients treated for secondary than primary indications, while that of FIT were similar in both groups. Out of 57 analysable FIT, 27 (47.4%) could have been prevented by fine tuning the device programming like the sustained rate duration or the VT discrimination algorithm. CONCLUSIONS: First inappropriate therapy occurred in 11% of 636 ICD recipients followed for ∼2 years. Nearly 50% of FIT could have been prevented by improving device programming

Contribution des isotopes de l’environnement pour la comprehension du fonctionnement de l’aquifere mio-plioquaternaire du Haouz de Marrakech (Maroc)

The study area «Haouz plain» is Located at the center of Morocco, it extend on a surface of 2800 km2, limited by the Jbilet hills in the North, the High-Atlas range in the South, R' dat wadi in the East and the Essaouira-Chichaoua plateau in the West. The area climate is semi-arid, characterized by low precipitations varying between 160 mm/year and 250mm/year and important variation in temperature between the winter and the summer with respectively 5°C and 45°C. Its hydrographic network is represented by the Tensift system which receives all the affluents of central and Westem Haouz. These affluents are characterized by weak flows with important seasonal variations. The Haouz plain is a sedimentary basin, being along the northern edge of the high atlas, it presents a geologic succession going from the primary to the recent Quaternary. The mio-plioquatemary formations, stemming from the dismantling of the atlasic chain, refuge an important and generalized water table on al1 the plain. This water table shows very variable hydrodynarnic characteristics, reflecting the complexity of the deep structures of the plain, 1986) and also the lithological variability of the mio-plioquatemary formations. The Haouz plain includes also the deep resemoirs of the Jurassic, Cretaceous and Eocene which finish some meters at the north of the Atlas, thus having a very limited extension and thereafter a low productivity. Five representative samples of water taken on the haouz water table were analyzed by the ABHT, the projection of these contents on the potability diagram enabled us to show that water of the water table generally has a good quality to passable. In the east quality becomes poor related to the existence of a zone arranged for agriculture (piezometer 1903/44). The nastiest potability is obsemed on the piezometer 3828/44 located at north of Marrakech at elazouzia zone of spreading of wom water of this city. The representation of the percentages of anions and major cations shows the prevalence of ions Ca2+ and HCO; and makes it possible to show up the Bicarbonate calcic facies of the water table. During these last decades, the use of stable isotopes, such oxygen 18 and deuterium, became necessary for the study of subsoil waters, it makes possible the estimation of the surfaces of refills, the determination of water origin. The samples taken on water points well distributed in the area of study allowed us a better comprehension of the function of the plioquatemary water table. The relation oxygen 18, deuterium shows that water is aligned on a line of slope 8.09, slightly different from the world meteoric line, thus characterizing precipitations of oceanic origin which did not endure notable isotopic fractionation therefore not important evaporation. Using the isotopic measures for the sarnples taken in January 2002 on wells well distributed in the area of study, allows us to show a variation of the contents of 018 with the altitude of the zones of refill. Thus we could delimit the surfaces of refill between 1500 and 800meters height. The relation oxygen-18 deuterium (δ2H = 8,9032 δ18O + 14,214 (R2 = 0,7449 ) translated an Atlantic mode of precipitations without remarkable evaporation.Parmi les aquifères régionaux importants de très grande extension au Maroc, celui du Haouz qui s’étend sur une superficie de 6.000 km2, circule au niveau du remplissage mioplioquaternaire issue du démantèlement de la chaîne Atlasique. Ce dernier présente un faciès constitué de galets, graviers, argiles, marnes et calcaires, dont la puissance atteint les 100 mètres. Cet aquifère joue un rôle très important dans l’alimentation en eau potable des habitants de la plaine du Haouz d’une population de plus de 4 millions d’habitants, en sus d’un complément a l’irrigation de 80.000 ha. Le climat aride de type continental, qui y règne se caractérise par des amplitudes thermiques assez importantes entre l’hiver et l’été. La pluviométrie présente une moyenne de 250 mm par an. La piézométrie de la zone étudiée est caractérisée par un écoulement général du sud vers le nord ouest en direction de l’oued Tensift, également principal collecteur des eaux de surface de la région. Une campagne de mesures isotopiques de plus d’une vingtaine d’échantillons prélevés en janvier 2002 au niveau de puits bien répartis dans la zone d’étude, au pu montrer une variation des teneurs en O" avec l’altitude des zones de recharge. En outre, la relation oxygene-18 deutérium (δ2H = 8,9032 δ18O + 14,214 (R2 = 0,7449 traduit un régime atlantique des précipitations, sans évaporation, ce qui implique que la recharge se fait rapidement, probablement a travers les formations miocènes gréseuses largement fissurées a l’affleurement de l’aquifère mío-plioquatemaire. Un gradient altitudinal moyen de -0,26 ‰ par 100 mètres est déterminé pour la plaine du Haouz, très proche des autres valeurs trouvées pour d’autres régions au Maroc, confirmant la validité régionale de celui-ci. Les variations des teneurs en oxygene-18 peuvent être interprétées en termes de différence d’altitude entre les altitudes de recharge et d’émergence

Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P <.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes

Recherche d'indicateurs de ruissellement et d'érosion par simulations de pluies sur les principaux sols du bassin versant du Rheraya (Haut-Atlas occidental, Maroc)

L'objectif de ce travail est d'étudier les risques de ruissellement et d'érosion dans le bassin versant du Rhéraya (Haut-Atlas du Maroc) au moyen d'un irrigateur manuel à rampe sur 1 m2. Nous recherchons des indicateurs faciles à déterminer directement sur le terrain (états de surface du sol) ou à partir des tests en laboratoire (stabilité des agrégats, texture, matière organique), qui soient bien corrélés avec l'infiltrabilité et la turbidité issues des tests d'infiltrométrie. Pour les différents sols affleurant dans le bassin, les résultats ont mis en évidence une grande variabilité de l'infiltrabilité (de 1 à 70 mm.h-1) et de turbidité des eaux de ruissellement (de 1,5 à 325 g.L-1). La turbidité a pu être mesurée correctement grâce à la mise au point d'un nouveau dispositif de collecte des eaux de ruissellement de l'irrigateur. Bien que l'infiltrabilité et le ruissellement soient la résultante d'interactions entre toutes les caractéristiques physiques du sol, certaines apparaissent dominantes dans notre contexte. Nous montrons ainsi que l'infiltrabilité est déterminée principalement par la texture et l'ouverture de la surface du sol et que la turbidité est due essentiellement à la surface de sol nu exposée au ruissellement. Ces indicateurs cartographiables offrent la possibilité d'une spatialisation des risques d'érosion au niveau du bassin versant

Differences in attitude, education, and knowledge about oral anticoagulation therapy among patients with atrial fibrillation in Europe: Result of a self-assessment patient survey conducted by the European Heart Rhythm Association

The purpose of this patient survey was to analyse the knowledge about blood thinning medications relative to gender, age, education, and region of residence in patients with atrial fibrillation (AF). A total of 1147 patients with AF [mean age 66 ± 13 years, 529 (45%) women] from eight European countries responded to this survey. Most patients understood that the indication for anticoagulation therapy was to 'thin the blood', but 8.1% responded that the purpose of the medication was to treat the arrhythmia. Patients with college or university grades reported less frequent deviations from their target INR range compared with those without schooling (2.8% vs. 5.1%, P < 0.05). The awareness of anticoagulation-related risk of bleedings was lowest in patients without schooling (38.5%) and highest in those with college and university education (57.0%), P < 0.05. The same pattern was also observed regarding patient's awareness of non-Vitamin K antagonist oral anticoagulants (NOACs): 56.5% of the patients with university education and only 20.5% of those without schooling (P < 0.05) knew about NOACs, indicating that information about new anticoagulation therapies remains well below the target. Bleeding events were statistically less frequent in patients on NOACs compared with Vitamin K antagonists. The education level and patients' knowledge have a direct influence on the global management of the anticoagulation. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016