Minimally invasive surgery ablation of SA-AF achieved satisfactory 1-year results when the bipolar radiofrequency was employed. Nevertheless, the relatively high complication rate reported suggest that such techniques require further refinement. Finally, the preliminary results of the hybrid approach are promising but they need to be confirmed.

Consecutive patients seen in the first-heart-aid service of a university hospital and given a diagnosis of noncardiac chest pain completed the self-report Hospital Anxiety and Depression Scale. Patients with a score >or=8 on either the anxiety or depression subscale (N=266, mean age=55.81 years, SD=13.03, 143 male patients) were compared with patients scoring <8 (N=78, mean age=60.55 years, SD=10. 84, 50 male patients) by means of the Mini International Neuropsychiatric Interview. Panic disorder and/or depression identified by the diagnostic interview were highly prevalent in the group with a score >or=8 (73.3% versus 3.9% in the comparison group). The Hospital Anxiety and Depression Scale is an adequate screening instrument for the detection of affective disorders in patients with noncardiac chest pain.

Both obesity and heart failure (HF) are highly prevalent syndromes in modern Western society. Nearly 60% of the U.S. population has a body mass index (BMI) Ͼ25 kg/m 2 (1). The incidence of HF approaches 10 per 1,000 among persons older than 65 years (2). Because both syndromes are highly prevalent, patients are likely to have both simultaneously.Surprisingly, obese HF patients have a better prognosis than normal-weight HF patients, giving rise to the so-called obesity paradox (3).Brain natriuretic peptide (BNP) and aminoterminal proBNP (NT-proBNP) are established diagnostic markers in HF. However, it is unclear how to interpret the levels of BNP in overweight patients, as BNP is cleared by the natriuretic peptide receptor type-C (NPR-C), which is abundantly expressed in adipocytes (4). Indeed, a negative correlation has been described between BNP and BMI (5-7). Interestingly, a similar correlation was recently described for NT-proBNP (8), which is not cleared by NPR-C. To reliably address these relationships, we investigated the effect of a decrease in BMI following bariatric surgery on the concentrations of BNP and NT-proBNP.We studied 22 patients (5 men,17 women; median age 38 years) referred to our general surgery department for surgical treatment of obesity. Blood samples were collected one day before surgery, three months after surgery, and six months after surgery.The medical history of the patients showed diabetes (n ϭ 6), hypertension (n ϭ 4), and myocardial infarction (n ϭ 1). No patient was known to have HF or be using diuretics, angiotensinconverting enzyme inhibitors, angiotensin receptor blockers, or spironolactone during the study. Four patients were using betablockers with no alternations during the study.We confirm the correlation between BNP and NT-proBNP versus BMI in the combined consecutive measurements (r ϭ Ϫ0.30, p Ͻ 0.05; r ϭ Ϫ0.41, p Ͻ 0.01, respectively). Body mass index decreased drastically after three months (p Ͻ 0.001) and six months (p Ͻ 0.001), whereas BNP and NT-proBNP concentrations significantly increased after three months (p Ͻ 0.01 for both) and six months (p Ͻ 0.01 for both) (Table 1).Our study rejects the hypothesis that the negative correlation between BNP and BMI is due to an upregulation of NPR-C because the NPR-C does not clear NT-proBNP. Given that both peptides derive simultaneously from the cleavage of their common predecessor proBNP, but are cleared via different mechanisms, the parallel associations between peptide concentrations and BMI suggest a relationship between adipose tissue and production.Taken together, our findings show that BNP and NT-proBNP concentrations increase with decreasing weight. This is likely to be due to decreased cardiac production of BNP, suggesting some yet undefined beneficial effects of obesity in HF that clearly warrant further study.