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Risk prediction for sudden cardiac death and ICD treatments 815(11.7 million inhabitants) between 2006 and 2010, we identified characteristics associated with an increased risk of pre-hospital SCD and used these variables to build a SCD prediction score which we validated internally and externally. Results: In the overall STEMI population, (n=8112; median age 60 years, 78% males), SCD occurred in 452 patients (5.6%). By multivariate analysis, younger age, absence of obesity, absence of diabetes, shortness of breath, and a short delay between pain onset and call to EMS were the main predictors of SCA. A score built from these variables predicted SCA, with the risk increasing 2-fold in patients with a score between 10 and 19, 4-fold with a score between 20 and 29, and more than 18-fold with a score ≥30, compared to those with scores <10. The SCA rate was 28.9% in patients with a score ≥30 compared to 1.6% in patients with a score ≤9 (P for trend<0.001). Sensitivity and specificity varied between 96.9% and 10.5% for scores 10 and above, and 18.0% and 97.6% for scores 30 and above, with scores between 20 and 29 achieving the best sensitivity and specificity (65.4% and 62.6%, respectively). Conclusion: Anticipating the occurrence of SCD at the acute phase of STEMI is feasible, and it should be added to the survival chain as a new link immediately before SCD (Figure). Near-term can accordingly be developed as a novel approach to reduce the burden of SCD 3874 | BEDSIDE Implantable cardiac defibrillator in the setting of tetralogy of fallot: data from the DAI-T4F National Registry Background: Tetralogy of Fallot (TOF) is the most frequent form of congenital heart disease managed by cardiologists, known to be at particularly risk of sudden cardiac death. However, few studies have reported long-term outcomes of TOF patients with implantable cardioverter defibrillator (ICD). Purpose: We aimed to report characteristics and outcomes from a large population of patients with TOF and ICD, implanted for primary or secondary prevention. Methods: Between 2005 and 2016, all TOF patients implanted with an ICD in 22 French centers were enrolled in this specific evaluation aiming to determine characteristics at implantation as well as outcomes (overall mortality, appropriate ICD therapies, and device-related complications) (DAI-T4F study, CNIL# 2029070). Results: Overall 101 patients (43±13 years, 69% males) were enrolled. A majority of patients were implanted in the setting of secondary prevention (71%), whereas the remaining (29%) were for primary prevention. Among the latter group, known risk factors for sudden cardiac death were: severe pulmonary regurgitation (25%,) prior palliative shunt (43%), syncope of unknown origin (21%), inducible ventricular tachycardia (39%), non-sustained ventricular tachycardia (29%), QRS duration ≥180ms (19%), features of left ventricular significant dysfunction (29% with ejection fraction ≤45%), and documented sustained supra ventricular tachycardia (46%). Thirty-seven patients (37%) received a singl...

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Introduction Mitral annular disjunction (MAD) is an anatomical variation of the mitral annulus, characterized by an atrial displacement of the leaflet’s hinge points. It is associated with severe ventricular arrhythmias (VA) in mitral valve prolapse (MVP). Purpose The aim of this study was to assess MAD in MVP by echocardiography, analyze the reproducibility of measurements and evaluate its importance for arrhythmic risk stratification along with strain analysis of myocardial deformation. Methods Two hundred and sixty patients with MVP were included. MAD was evaluated and measured by two observers in the parasternal long axis and in the apical views. Myocardial longitudinal strain was analyzed by speckle-tracking. Results Ninety four patients (36.2%) of MVP patients presented MAD. These patients were younger (53.7 ± 15.1 vs 58.4 ± 17.6, p = 0.033) with higher rate of atypical chest pain (21.3% vs 11.5%, p = 0,041) and bileaflet prolapse (50.5% vs 32.3%, p = 0.004). Para-sternal long-axis view was the incidence of choice to detect MAD with a moderate inter-observer concordance (Kappa of 0.55), good correlation (r = 0.69, p &lt; 0.01) and inter-class correlation coefficient (0.82; 0.67 – 0.90). Twenty patients (7.7%) had a history of severe VA. Among them, no difference was noted in terms of presence (35% vs 36.3%, p = 0.911) or length of MAD (11.1 ± 2.5 vs 11.2 ± 3.1, p = 0.937). However, deformation analysis showed reduced global longitudinal strain (18.6 ± 3.1 vs 21.3 ± 3.3%, p = 0.001) and higher mechanical dispersion values (46 ± 13 vs 37.4 ± 12.9 ms, p = 0.002)in comparison to the rest of the MVP population. Conclusion No significant association was found between severe VA and the presence or severity of MAD in MVP patients. Increased mechanical dispersion and reduced global longitudinal strain may be helpful for arrhythmic risk stratification. Abstract P668 Figure. Comparison of MD and GLS