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Background: Atrial fibrillation (AF) guidelines recommend that symptom relief be a primary goal in management. However, patient perception of their prevailing rhythm is often inaccurate, complicating symptom-targeted treatment., Objective: The purpose of this study was to evaluate the accuracy of patient perception of their prevailing rhythm and identify factors that predict inaccuracies., Methods: Demographic and health status data were captured by questionnaires for 458 outpatients with documented AF. AF burden (%) was captured by 1-week continuous heart monitors. Patients estimated the length and frequency of their AF episodes by completing the AF Symptom Severity questionnaire. Patient reports were compared to AF burden, and outliers were identified and broken into 2 groups: patients with AF burden <10% who indicated near-continuous AF (overestimators) and patients with AF burden >90% who estimated little to no AF (underestimators). Multinomial logistic regression was used to identify predictors of inaccuracies (over- or underestimators)., Results: By continuous monitor, 15% of patients were found to be over- or underestimators. Persistent AF, female sex, older age, anxiety, and depression were predictive of inaccurate patient perception. Persistent AF, female sex, and older age were predictive of underestimating, while mood disorders (anxiety and depression) were predictive of overestimating. The prevalence of underestimators was nearly twice that of overestimators., Conclusion: Sex, age, and mood disorders are among factors that lead to inaccurate patient perception of their prevailing rhythm in patients with AF. Such modulating factors should be considered when evaluating treatment strategies. Consideration should be given to more liberal use of heart monitors in these patient populations to better target therapy., (Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Background: Pectus excavatum is a skeletal abnormality that may have cardiac manifestations., Objective: To determine whether pectus excavatum is associated with lone atrial fibrillation (AF)., Methods: The pectus severity index (PSI) is the ratio of the lateral diameter of the chest to the distance between the sternum and the spine on computed tomography scan. A normal PSI is ≤2.5 whereas patients with severe pectus excavatum have a PSI >3.25. We calculated the PSI of 220 consecutive patients with AF who underwent radiofrequency catheter ablation from September 2008 to 2012 and compared this to the PSI of 225 controls without a history of AF undergoing chest computed tomography., Results: Mean PSI was higher in patients with lone AF (2.72 ± 0.07) compared to patients with nonlone AF (2.25 ± 0.03) or controls (2.26 ± 0.03) (P < .001). The likelihood of mild, moderate, or severe pectus excavatum was higher in patients with lone AF compared to patients with nonlone AF and controls (P < .001). Patients with lone AF were more than 5 times as likely to have severe pectus excavatum compared to patients with nonlone AF or controls (P < .001) even after adjustment for potential confounders., Conclusions: Nearly two-thirds of the patients with lone AF have at least mild pectus excavatum and 17% have severe pectus, which is significantly higher than in patients with nonlone AF or controls. This association suggests a potential genetic or mechanical abnormality may be common to the 2 disorders. Our study may provide insight into the pathogenesis of lone AF., (Copyright © 2013 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Background: Catheter ablation is an effective treatment for medically refractory, disabling atrial fibrillation (AF). Ablation success may be limited in patients with persistent or long-standing persistent AF. A pericardioscopic, hybrid epicardial-endocardial technique for AF ablation may be a preferred approach for such patients. Limited data are available using such an approach., Objective: To evaluate 1-year outcomes of a hybrid technique for AF ablation., Methods: A cohort of 101 patients underwent AF ablation using a transdiaphragmatic pericardioscopic, hybrid epicardial-endocardial technique. Patients were followed with 24-hour Holter monitors at 3-, 6-, and 12-month intervals. Symptom severity was assessed at baseline and follow-up by using the Canadian Cardiovascular Society Severity of Atrial Fibrillation scale., Results: Mean AF duration was 5.9 years; 47% were persistent and 37% were long-standing persistent. Mean left atrial size was 5.1 cm (range 3.3-7 cm). Overall, 12-month arrhythmia-free survival was 66.3% after a single ablation procedure and 70.5% including repeat ablation. Repeat ablation was required in 6% of the patients and antiarrhythmic drug therapy in 37% of the patients. Quality of life improved significantly and was durable over 12-month follow-up. There were 2 deaths, which occurred in the early postoperative period: one due to atrioesophageal fistula and the second due to sudden cardiac death without apparent cause by autopsy., Conclusions: We report the largest series to date of a hybrid epicardial-endocardial, stand-alone ablation procedure using a pericardioscopic technique for the treatment of AF. While respecting the identified complications, our results demonstrate a high potential for successful treatment in a challenging patient population with AF., (Copyright © 2013 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Introduction: Owing to the very great age and the polypathology of the patients in geriatrics, we are often confronted to the palliative care decision., Purpose: The purposes of this retrospective study were both to define the criteria leading to palliative care and to analyse the evolution of patients., Method: We analysed 40 files of patients hospitalised in Geriatric internal medicine or Geriatric rehabilitation departments over 11 months., Results: Mean age was 85.4 years and 62.5% of patients were females. Infections, heart failure, general weakness, orthopaedic affections, strokes and cancers were the main causes of hospitalisation. Patients had 3 medical or surgical histories of chronic or cured serious diseases and a MMSE average value of 17.7. The rate of malnutrition was 92% and 90% of patients were very dependent. Severe infections, cancers, heart failure and severe pressure ulcers were the main affections for decision of palliative care. The latter was always decided by the staff with patients or families taking part in 8 cases and being informed in other cases. The palliative care lasted 7 days on average. Morphine was used in 31 cases. No artificial nutrition was introduced., Conclusion: The decision of palliative care is very complex since great age, polypathology, great dependence and high prevalence of cognitive disorders are frequent in this population.