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Background Contemporary registries on atrial fibrillation (AF) are scare in North African countries. Hypothesis In the context of the epidemiological transition, prevalence of valvular AF in Tunisia has decreased and the quality of management is still suboptimal. Methods NATURE‐AF is a prospective Tunisian registry, involving consecutive patients with AF from March 1, 2017 to May 31, 2017, with a one‐year follow‐up period. All the patients with an Electrocardiogram‐documented AF, confirmed in the year prior to enrolment were eligible. The epidemiological characteristics and outcomes were described. Results A total of 915 patients were included in this study, with a mean age of 64.3 ± 22 years and a male/female sex ratio of 0.93. Valvular AF was identified in 22.4% of the patients. The mean CHA2DS2VASC score in nonvalvular AF was 2.4 ± 1.6. Monotherapy with antiplatelet agents was prescribed for 13.8% of the patients. However, 21.7% of the subjects did not receive any antithrombotic agent. Oral anticoagulants were prescribed for half of the patients with a low embolic risk score. In 341 patients, the mean time in therapeutic range was 48.87 ± 28.69%. Amiodarone was the most common antiarrhythmic agent used (52.6%). During a 12‐month follow‐up period, 15 patients (1.64%) had thromboembolism, 53 patients (5.8%) had major hemorrhage, and 52 patients (5.7%) died. Conclusions NATURE‐AF has provided systematic collection of contemporary data regarding the epidemiological and clinical characteristics as well as the management of AF by cardiologists in Tunisia. Valvular AF is still prevalent and the quality of anticoagulation was suboptimal.

The NATURE-HF registry was aimed to describe clinical epidemiology and 1-year outcomes of outpatients and inpatients with heart failure (HF). This is a prospective, multicenter, observational survey conducted in Tunisian Cardiology centers. A total of 2040 patients were included in the study. Of these, 1632 (80%) were outpatients with chronic HF (CHF). The mean hospital stay was 8.7 ± 8.2 days. The mortality rate during the initial hospitalization event for AHF was 7.4%. The all-cause 1-year mortality rate was 22.8% among AHF patients and 10.6% among CHF patients. Among CHF patients, the older age, diabetes, anemia, reduced EF, ischemic etiology, residual congestion and the absence of ACEI/ ARBs treatment were independent predictors of 1-year cumulative rates of rehospitalization and mortality. The female sex and the functional status were independent predictors of 1-year all-cause mortality and rehospitalization in AHF patients. This study confirmed that acute HF is still associated with a poor prognosis, while the mid-term outcomes in patients with chronic HF seems to be improved. Some differences across countries may be due to different clinical characteristics and differences in healthcare systems.

Background Pseudoaneurysm of inferior wall of the left ventricle is an uncommon complication of myocardial infarction with high mortality. Case presentation We report the case of a 63-year-old Tunisian man, diagnosed with a thrombosed left ventricular pseudoaneurysm and a pericardial effusion after 1 week of angina. Conclusions Left ventricular pseudoaneurysm is a serious complication of myocardial infarction that has atypical presentations. Diagnosis is generally established by transthoracic echocardiography but confirmed by magnetic resonance imaging. Urgent surgery is the treatment choice given the risk of embolization and rupture.

An 18-year-old male was referred to us for chest discomfort. A physical examination showed normal findings. The chest X-ray was also normal. ECG showed sinus rhythm and ischaemic changes in apico-infero-posterior myocardium. Two-dimensional-TTE (2DTTE) (Supplementary data online, Movie S1) showed a single, large oval cyst (39 × 56 × 38 mm). The edge was well defined (Panel A), it was intramyocardial and fluid-filled. It was located in the infero-postero-apical segment, protruding into the pericardium but mainly bulging into the left ventricular cavity (Supplementary data online, Movie S2). L3DTTE (Supplementary data online, Movie S3) allowed cropping of this cystic mass in transverse, sagittal (Panel B), and oblique planes, showing an apico-infero-posterior intramyocardial ellipsoid cystic mass with liquid content and well-defined edges. These data showed a life-threatening mass, mainly due to the possibility of intrapericardial and/or left ventricular rupture as well as systemic embolization. Chest computed tomography (CT) (Panel C) confirmed the presence of a left ventricular intramyocardial cyst and also a multivesicular hepatic cyst. The patient was referred to cardiac surgery. Surgical findings (Panel D) confirmed the accuracy of the preoperative echocardiography. The postoperative course was uneventful and the patient was discharged in stable condition. Three months later, his hepatic cyst was removed with no complications. Two-dimensional TTE remain the widely used imaging modality in cardiac echinococcosis, L3DTTE was shown to complement 2DTTE by displaying the 3D volume of the cyst and spatial relation to the neighbouring cardiac structures. This information is vital, especially since surgical removal of the cyst is the treatment of choice for this uncommon, but life-threatening disease.