Abstract Background Simulation-based training has demonstrated effectiveness in enhancing proficiency in interventional procedures. The endovascular treatment of peripheral arterial lesions has become a prominent minimally invasive therapeutic option. However, operators from various specialties, including Interventional Cardiology, Interventional Radiology, and Vascular Surgery, often follow diverging guideline recommendations and training pathways. Despite growing use of simulation in this field, the influence of an operator’s specialty on learning outcomes remains poorly understood. Objective This study aimed to evaluate the impact of simulation training on peripheral angioplasty performance scores across different interventional specialties and assess how specialty-specific factors influence skill acquisition. Methods This quasi-experimental observational study will be conducted at the Simulation Center of the Faculty of Medicine of Sfax, Tunisia (trial registration: PACTR Trial ID 30697). Participants consist of 60 novice fellows from three specialties: Cardiology (n=20), Interventional Radiology (n=20), and Vascular Surgery (n=20). All participants will undergo identical simulation training using a high-fidelity Mentice simulator, comprising five standardized clinical scenarios addressing peripheral angioplasty of complex iliac and femoral lesions (TASC B-D). Each participant will receive a 4-hour hands-on training session with pre- and posttest assessments using a 25-item Global Score (10 knowledge items, 15 competence items). Primary outcomes consist of percentage change in performance scores from baseline to posttraining (threshold for clinical significance:≥25% improvement) and comparison across specialty groups using nonparametric statistics. Secondary outcomes consist of radiation protection parameters, including fluoroscopy duration, cumulative radiation dose, air kerma, and dose area product (KAP), measured by a simulator with real-time ALARA (As Low As Reasonably Achievable) feedback. Results Study enrollment started on September 15, 2024. As of December 2025, 42 fellows were screened, and 21 have been enrolled (15 Cardiology, 3 Radiology, 3 Vascular Surgery), representing 35% of the target sample (21/60). All 21 enrolled participants completed the full simulation training protocol, with radiation protection parameters recorded for all sessions. Enrollment and data collection are expected to be completed by June 2026, with full results anticipated for publication thereafter. Conclusions This protocol describes the first comparative study evaluating the impact of high-fidelity simulation on peripheral angioplasty performance across three distinct specialties. Findings are anticipated to provide novel evidence regarding specialty-specific learning trajectories and may inform the development of standardized, specialty-tailored training pathways for complex peripheral interventions.

Background:Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in the Middle East and Africa (MEA), with a rising incidence particularly among women. Regional factors such as limited health care access, cultural barriers, and sex-specific risk factors exacerbate this burden. Despite this, women remain significantly underrepresented in cardiovascular research, and no large-scale, multicenter prospective trials have been conducted to provide national data. To address this gap, we established the Middle East African Registry Women Cardiovascular Disease (MEA-WCVD) to create a comprehensive database on the epidemiological profile and management of heart failure (HF), atrial fibrillation (AF), ischemic heart disease (IHD), and valvular heart disease (VHD) in women. Objective:The primary aim of this study is to compare the management of CVDs in women and men across MEA countries in accordance with current clinical practice guidelines. The study also seeks to identify gender-based disparities in health care insurance, income, and access to cardiovascular services. Methods:The MEA-WCVD is a prospective, multicenter, observational study enrolling consecutive patients aged ≥18 years with diagnosed HF, AF, IHD, or VHD across 25 tertiary care centers. Participants provide informed consent during a single visit, and trained investigators collect sociodemographic, clinical, and treatment data via electronic case report forms. The electronic case report form captures general characteristics (age, gender, and comorbidities) and diagnosis-specific details (imaging, guideline-based therapies, and complications). Data are stored in a centralized, contract research organization-managed database (Eshmoun-Clinical Research, Tunisia). An initial 75-day enrollment phase (May 2023-July 2023) is followed by a planned 1-year follow-up for outcome analysis. Data will be analyzed using SPSS (version 25) to compare gender disparities in management and outcomes using multivariable regression and survival analyses. Results:The MEA-WCVD study was funded in April 2023, and data collection began in May 2023. As of July 2023, a total of 15,366 participants have been enrolled across 25 centers. A 1-year follow-up is expected to be completed by July 2024. Data analysis is planned to commence in July 2024, with primary results anticipated for publication in March 2025. The study aims to establish the largest registry in the MEA region for HF, AF, IHD, and VHD, providing valuable insights into demographic trends, clinical management, and adherence to current guidelines. Conclusions:The MEA-WCVD registry will provide essential real-world data on the management and outcomes of the most prevalent CVDs (HF, AF, IHD, and VHD) in the MEA region. By directly comparing standard care management between men and women, this study will highlight gender disparities and inform future strategies for equitable cardiovascular care. The registry is expected to contribute to the largest contemporary cohort of patients with CVD in the region, advancing knowledge in cardiovascular epidemiology and clinical practice.

Background Intracardiac masses are rare, occurring in approximately 0.1%-0.3% of patients undergoing echocardiography. They include thrombi, vegetations, and tumours. Echocardiographic identification is often challenging and can be misleading.Case summary We report a 72-year-old man admitted for concomitant deep vein thrombosis and a transient ischaemic stroke. Transthoracic echocardiography showed a small mass appended to the mitral valve. Transoesophageal echocardiography, performed to investigate paradoxical embolism showed a hyperechoic, mobile mitral mass attached to the leaflets closure line, without mitral regurgitation or stenosis. Valvular fibroelastoma, myxoma, and endocarditis were considered in the differential diagnosis; however, inflammatory markers and microbiological tests were unremarkable. Whole-body CT revealed pancreatic cancer, supporting the diagnosis of marantic endocarditis. The patient received curative anticoagulation with apixaban and was referred to an oncologist. The evolution was favourable after 3 months.Discussion We will discuss through our case and a literature review of the distinctive clinical and echocardiographic features of valve mass diagnosis.

The escalating incidence of cardiovascular disease (CVD) in the general population, particularly among women, has resulted in increased morbidity and mortality in the Middle East and African (MEA) Regions. Despite this concerning tendency, women remain significantly underrepresented in cardiovascular research, with no large-scale prospective multicenter trials reflecting national data published to date. To address this gap, we initiated the "Women CardioVascular Disease Middle East African Registry (MEA-WCVD)" to establish a comprehensive database on the contemporary epidemiological profile and management of Heart Failure (HF), Atrial fibrillation (AF), ischemic heart disease (IHD) and Valvular Heart disease (VHD) in women. This study aims to compare the management of cardiovascular diseases in women and men in a MEA countries sample, according to the current practice guidelines and encompass the identification of gender-based disparities, specifically examining healthcare insurance, income, and access to healthcare services. This prospective observational study involves a one-shot visit where patients diagnosed with HF, AF, IHD, or VHD provide informed consent, and their data are collected in a centralized certified database. The registry spans 75 days, with plans for an extended protocol to assess 1-year clinical outcomes. The study's findings, expected at the conclusion, will include a comprehensive evaluation of the demographic profile and care management practices for the most prevalent cardiovascular diseases in women worldwide, aligned with current guidelines. The MEA-WCVD registry is anticipated to become the largest database for Middle East African patients monitored for HF, AF, IHD, and VHD. The MEA-WCVD registry will provide unique and necessary data on the management and outcomes of the most common CV diseases (AF, HF, IHD and VHD) while comparing standard care management in women to men in MEA regions. This study will yield the largest contemporary cohort of patients with cardiovascular diseases in MEA countries and would provide valuable answers about real-world cardio-vascular clinical epidemiology and management.

Introduction: Nemaline myopathy (NM), also known as Nemalinosis, is a rare congenital muscle disease with an incidence of 1 in 50000. It is characterized by nemaline rods in muscle fibers, leading to muscle weakness. We reported a case of NM revealed by cardiac involvement, and we highlighted the challenges in diagnosing this condition as well as its poor prognosis. Observation: The patient is a 7.5-month-old infant from a consanguineous marriage, with a history of bronchiolitis and psychomotor retardation. The infant was admitted to the paediatric intensive care unit due to respiratory distress, which necessitated intubation and mechanical ventilation. A chest X-ray revealed cardiomegaly and bilateral bronchial syndrome, while an electrocardiogram showed left ventricle hypertrophy. Emergency echocardiography revealed biventricular hypertrophy. Laboratory tests indicated significant rhabdomyolysis, hepatic cytolysis, microcytic hypochromic anaemia, negative troponins, and respiratory acidosis. The enzymatic activity of acid alpha-glucosidase was inconclusive. Genetic analysis for mutations in exon 2 associated with Pompe disease and congenital muscular dystrophy, the most common differential diagnoses, returned negative results. Given the presence of rhabdomyolysis, the emergence of tongue fasciculations, and pronounced axial and peripheral hypotonia, a muscle biopsy was performed. This revealed the presence of nemaline rods, confirming the diagnosis of NM. The patient’s condition deteriorated, marked by extubating failure due to severe muscle weakness. The infant passed away after 50 days of hospitalization. Conclusion: This case underscores the severity and complexity of NM revealed by hypertrophic cardiomyopathy, emphasizing the importance of early diagnosis and prenatal genetic counseling.

Cardiovascular disease (CVD) is a major health burden worldwide, yet gender-specific data from the Middle East and North Africa (MENA) region remain scarce. The Middle East African Registry of Women with Cardiovascular Disease enrolled adult patients with coronary heart disease (CHD), heart failure (HF), atrial fibrillation (AF), or valvular heart disease (VHD) across Tunisia between May and July 2023. Of 15,366 patients, 37.6% were women. Compared with men, women were older, had lower socioeconomic status, and presented with more obesity, hypertension, diabetes, dyslipidemia, and sedentary lifestyle but smoked less. CHD was less frequent in women, while AF and VHD were more prevalent. Women underwent fewer coronary angiographies and percutaneous interventions, experienced longer delays, and received fewer guideline-based therapies, including dual antiplatelet agents and high-intensity statins. Among HF patients, women more often had preserved ejection fraction and higher hospitalization rates. These results highlight persistent gender inequities in CVD care in Tunisia.

INTRODUCTION:There are no clear data on the incidence and predictors of arterial and venous thromboembolic (TE) events in COVID-19 ambulatory patients. AIM:We conducted this study to analyze thromboembolic complications in this setting and to compare the efficacy and safety of Rivaroxaban to LMWHs as a thromboprophylaxis treatment. METHODS:This is an observational study including COVID-19 patients treated on an outpatient basis. We analysed the predictors of thromboembolic events. RESULTS:We included 2089 patients with COVID19 managed on an outpatient basis during the period from October 01, 2020 to December 31, 2021. The mean age of our patients was 43±16 years. The incidence of venous and arterial TE complications was 0.9%. Predictive factors for arteriovenous thromboembolic complications were hormonal contraception (OR=23), moderate clinical form (OR=3.5), recent surgery or miscarriage in the month preceding COVID-19 (OR=9.2) and CT signs of COVID-19 (OR=4.9). In contrast, physical activity proved to be a protective factor. Thromboprophylaxis was prescribed in 22.5% of cases: LMWH in 18.1%, Rivaroxaban in 3.7% and a combination of the two molecules successively in 0.6% of patients. There was no statistical difference in thromboembolic or major bleeding complications between the Rivaroxaban and LMWH groups. CONCLUSION:Our study showed that the incidence of thromboembolic complications is very low in Covid-19 ambulatory patients.

Introduction : Il n'existe pas de données claires sur l'incidence et les facteurs prédictifs des événements thromboemboliques (TE) artériels et veineux chez les patients atteints de COVID-19 et traités en ambulatoire. Objectif : Analyser les complications TE chez les patients atteints de COVID-19 et comparer l’efficacité et la sécurité du Rivaroxaban aux héparines à bas poids moléculaires (HBPM) dans le traitement prophylactique Méthodes : Il s'agit d'une étude observationnelle incluant des patients atteints de COVID-19 et traités en ambulatoires. Nous avons relevé les facteurs prédictifs de complications thromboemboliques. Résultats : Nous avons inclus 2089 patients atteints de COVID19 et gérés en ambulatoire durant la période allant du 01 octobre 2020 au 31 décembre 2021. L’âge moyen de nos patients était de 43±16 ans. L'incidence des complications TE veineuses et artérielles était de 0,9%. Les facteurs prédictifs de complications thromboemboliques artério-veineuses étaient la contraception hormonale (OR=23), la forme clinique modérée (OR=3,5), la chirurgie récente ou les fausses couches dans le mois précédant l’atteinte par la COVID-19 (OR=9,2) et les signes tomodensitométriques de COVID-19 (OR=4,9). Par contre, l’activité physique s’est avérée être un facteur protecteur. Une thromboprophylaxie a été prescrite chez 22,5% des cas : l’HBPM dans 18,1% des patients, du Rivaroxaban chez 3,7% des patients et l’association des deux molécules successivement chez 0.6% des patients. Nous n’avons pas constaté de différence statistique concernant les complications thromboemboliques ni hémorragiques majeures entre le groupe traité par Rivaroxaban et le groupe traité par HBPM. Conclusions : Notre étude a montré que l'incidence des complications ...(résumé tronqué à 250 mots)

INTRODUCTION:Post-COVID syndrome, a long-term consequence of the COVID-19 pandemic, remains insufficiently understood. This study aimed to estimate the prevalence of post-COVID syndrome, describe its clinical spectrum, and identify associated factors among patients with non-severe forms of the disease. METHODS:We conducted a cross-sectional study using telephone interviews in Sfax, southern Tunisia, during January 2021. The study population included individuals who tested positive for SARS-CoV-2 in October 2020. Minors and deceased individuals were excluded. Post-COVID syndrome was defined as the persistence of symptoms for more than eight weeks following the initial COVID-19 diagnosis. RESULTS:A total of 2,070 patients were enrolled. The sample included 1,230 women (59.4%), with a male-to-female ratio of 0.68. The median age was 40 years [semi-interquartile range (SIR): 12.5 years]. The prevalence of post-COVID syndrome was 41.6% (n = 861). Among these, 229 patients (26.5%) consulted a physician for persistent symptoms, and 122 (14.13%) underwent further paraclinical evaluation. The most commonly reported symptoms were ageusia (68.9%), cognitive difficulties including concentration and memory impairment (24.9%), and fatigue (17.4%). Independent factors significantly associated with post-COVID syndrome included: age under 60 years (AOR = 1.8; 95% CI: 1.50-2.66), female gender (AOR = 1.6; 95% CI: 1.35-1.96), history of chronic respiratory disease (AOR = 1.8; 95% CI: 1.2-2.8), history of cancer (AOR = 3.5; 95% CI: 1.03-12.2), anticoagulant therapy (AOR = 1.45; 95% CI: 1.1-1.8), salicylic acid use (AOR = 1.4; 95% CI: 1.1-1.9), and initial clinical severity categorized as mild (AOR = 5.5; 95% CI: 3.5-8.5) or moderate (AOR = 7.1; 95% CI: 4.2-11.9). CONCLUSION:A better understanding of the long-term manifestations of COVID-19, such as post-COVID syndrome, is essential. In the context of widespread vaccination and evolving variants, multidisciplinary approaches must be reconsidered to improve patient follow-up and healthcare strategies.

Background: The prevalence of cardiac implantable electronic devices (CIEDs) in Tunisia is rising because of increased life expectancy and broader indications. This has led to a higher incidence of complications related to vascular access, device pockets, leads, and patient characteristics. Objective: We aimed to evaluate the prevalence, types, and predictors of complications occurring within the first year after CIED implantation and to profile the demographic and epidemiologic characteristics of CIED recipients in Tunisia. Methods: The National Tunisian Multicenter Prospective Study on Cardiac Implantable Electronic Devices is a nationwide, prospective study. We enrolled consecutive patients, from January 2021 to February 2022, undergoing de novo implantation of pacemakers, implantable cardioverter defibrillators, cardiac resynchronization therapy devices, generator replacements, and upgrading procedures. Patients attended 4 follow-up visits within the first year. Results: We enrolled 1500 patients with a mean age of 70.1 ± 15.2 years. Most (86.5%) received conventional pacemakers. The overall complication rate was 8.6%, with 129 complications in 80 patients. No significant associations were found between age or gender and complication rates. However, overweight and obesity were independent predictors of overall complications. Procedures performed in private health care settings were associated with a 56.2% reduction in complication rates. Generator replacements were linked to a 64.2% decrease in complication rates. Conversely, urgent or out-of-hours procedures increased the risk of complications by 62.7%. Procedures performed by non-electrophysiologist implanters were associated with an 89.5% increase in overall complication rates. Conclusion: Complications were more prevalent with cardiac resynchronization therapy devices. Identifying specific procedural predictors may pinpoint patients at higher risk, affecting personalized treatments and CIED implantation strategies.

INTRODUCTION:Nemaline myopathy (NM), also known as Nemalinosis, is a rare congenital muscle disease with an incidence of 1 in 50000. It is characterized by nemaline rods in muscle fibers, leading to muscle weakness. We reported a case of NM revealed by cardiac involvement, and we highlighted the challenges in diagnosing this condition as well as its poor prognosis. OBSERVATION:The patient is a 7.5-month-old infant from a consanguineous marriage, with a history of bronchiolitis and psychomotor retardation. The infant was admitted to the paediatric intensive care unit due to respiratory distress, which necessitated intubation and mechanical ventilation. A chest X-ray revealed cardiomegaly and bilateral bronchial syndrome, while an electrocardiogram showed left ventricle hypertrophy. Emergency echocardiography revealed biventricular hypertrophy. Laboratory tests indicated significant rhabdomyolysis, hepatic cytolysis, microcytic hypochromic anemia, negative troponins, and respiratory acidosis. The enzymatic activity of acid alpha-glucosidase was inconclusive. Genetic analysis for mutations in exon 2 associated with Pompe disease and congenital muscular dystrophy, the most common differential diagnoses, returned negative results. Given the presence of rhabdomyolysis, the emergence of tongue fasciculations, and pronounced axial and peripheral hypotonia, a muscle biopsy was performed. This revealed the presence of nemaline rods, confirming the diagnosis of NM. The patient's condition deteriorated, marked by extubating failure due to severe muscle weakness. The infant passed away after 50 days of hospitalization. CONCLUSION:This case underscores the severity and complexity of NM revealed by hypertrophic cardiomyopathy, emphasizing the importance of early diagnosis and prenatal genetic counseling.

The benefits of permanent cardiac pacing have been widely demonstrated. However, the literature on complications remains inconsistent. We lack precise information about the frequency of complications and their predictive factors in our center. The purpose of this study was to determine the frequency of complications related to permanent cardiac pacing in our centre and to specify their predictive factors. We conducted a retrospective, observational, descriptive and analytical study. It involved patients who underwent an implantable electronic device (CIED) procedure, such as a pacemaker (PM) or implantable cardioverter-defibrillator (ICD) at the University Hospital Center of Sfax, Tunisia between January 2009 and December 2013. All clinical and paraclinical characteristics of the patients, their procedural data and any potential complications related to CIED implantation were collected (infectious complications, pocket hematomas, lead-related complications, vascular access complications, and complication-related mortality). Appropriate statistical tests were used to analyze the incidence of complications and their associated factors through multivariate analysis and to perform a survival analysis. We collected data from 462 procedures, including 420 PMs and 42 ICDs. The population had an average age of 72 +/- 15 years. Hypertension was present in 55.1% of cases, diabetes in 22.3%, and 63.38% had underlying heart disease. A total of 64 complications were noted, accounting for 11.5% of the procedures. Complications were significantly more frequent with ICDs than PMs (23.8% vs. 10.2%; p=0.04). The incidence of infectious complications was 1.96%. Associated risk factors included diabetes (adjusted OR: 4.35, 95% CI1.08-17.48; p=0.038) and reduced left ventricular ejection fraction (adjusted OR: 9.2, 95% CI 1.83-46.12; p=0.007). The incidence of pocket hematomas was 1.53%, with its associated risk factor being an indication for therapeutic anticoagulation (adjusted OR: 29.05, 95% CI 3.42246.57; p=0.002). Lead-related complications were the most common (73.4% of complications). Their independent predictive factor was the number of manipulations greater than one (adjusted OR: 3.66, 95% CI 0.98-13.61; p=0.05). Among this subgroup, lead displacement was the most frequent (40.05%), with the presence of hypertensive heart disease as an associated risk factor (adjusted OR: 3.99, 95% CI 1.2-13.1; p=0.019). Vascular access complications were rare, occurring in 0.21% of cases. Mortality related to complications of cardiac device implantation was high (13.2%), particularly in the case of infectious complications (p=0.04). Overall survival at 5 years was 84.5%. The incidence of IEDC-related complications in the short and long term at our center was high, with a significant associated mortality, although comparable to the literature data. By identifying associated risk factors such as diabetes, heart failure, therapeutic anticoagulation, and repeat surgeries, we can adopt an informed therapeutic approach to reduce complications.

Cirrhosis is the final stage in the development of hepatic fibrosis in chronic liver disease. It is associated with major hemodynamic disturbances defining the hyperdynamic circulation and may be complicated by specific cardiac involvement or cirrhotic cardiomyopathy which is a silent clinical condition that typically remains asymptomatic until the late stages of liver disease.Recently, new criteria defining CC, based on modern concepts and knowledge of heart failure, have been proposed. Despite knowledge of the main mechanisms behind this entity, there is no specific treatment available for cirrhotic cardiomyopathy. The management approach for symptomatic cardiomyopathy in cirrhotic patients is similar to that for left ventricular failure in non-cirrhotic individuals.

Heart failure with reduced ejection fraction (HFrEF) is still associated to a high rate of mortality and re-hospitalization. New HF therapy such as SGLT2 inhibitors (SGLT2i) and sacubitril valsaratan (ARNI) had proven to be effective in reducing morbidity and mortality. But the effect of these therapies on echographic and haemodynamic parameters measured by impedance cardiography (ICG) data is still controversial. To evaluate the impact of HF treatment guided by ICG haemodynamic study at 6-months rehospitalization and mortality. A prospective monocentric study (with a case control group) conducted between June 2021 and November 2022. Patients included had left ventricle ejection fraction (LVEF ≤ 40%), a creatinine clearance > 30 mL/min and no other severe pathology that could alter the prognosis. All patients had echocardiographic and hemodynamic study with a follow-up at 6 months. A total of 127 patients with HFrEF were included. The mean LVEF of our patients increased from 26% to 29% and LV filling pressures were elevated in 22.7% at inclusion and 13.2% at 6-months follow up. The 6-month rehospitalization and death rates were 22.8% and 18.1% respectively. The ARNI/SGLT2i group had significantly lower rates of rehospitalization and death from cardiovascular causes with P = 0.001 and P = 0.015 respectively. In the multivariate study, tachycardia, renal failure and elevated resistance measured by ICG were independent factors associated with mortality (OR = 6.56, P = 0.05; OR = 13.457, P = 0.03 and OR = 10.354, P = 0.03 respectively) while reduced intra thoracic fluid and optimal medical therapy were protective factors (OR = 0.866, P = 0.002 and OR = 0.035, P = 0.03 respectively). A controlled volemia collected by ICG and gliflozin treatment were independent protective factors of re-hospitalization in multivariate study (OR = 0.257, P = 0.02 and OR = 0,239, P = 0.02 respectively). The HFrEF is still a disease with a poor prognosis. Hemodynamic parameters measured by impedance cardiography could improve the disease profiling and patients' management in the era of new therapies.

Background In Tunisia, the number of cardiac implantable electronic devices (CIEDs) is increasing, owing to the increase in patient life expectancy and expanding indications. Despite their life-saving potential and a significant reduction in population morbidity and mortality, their increased numbers have been associated with the development of multiple early and late complications related to vascular access, pockets, leads, or patient characteristics. Objective The study aims to identify the rate, type, and predictors of complications occurring within the first year after CIED implantation. It also aims to describe the demographic and epidemiological characteristics of a nationwide sample of patients with CIED in Tunisia. Additionally, the study will evaluate the extent to which Tunisian electrophysiologists follow international guidelines for cardiac pacing and sudden cardiac death prevention. Methods The Tunisian National Study of Cardiac Implantable Electronic Devices (NATURE-CIED) is a national, multicenter, prospectively monitored study that includes consecutive patients who underwent primary CIED implantation, generator replacement, and upgrade procedure. Patients were enrolled between January 18, 2021, and February 18, 2022, at all Tunisian public and private CIED implantation centers that agreed to participate in the study. All enrolled patients entered a 1-year follow-up period, with 4 consecutive visits at 1, 3, 6, and 12 months after CIED implantation. The collected data are recorded electronically on the clinical suite platform (DACIMA Clinical Suite). Results The study started on January 18, 2021, and concluded on February 18, 2023. In total, 27 cardiologists actively participated in data collection. Over this period, 1500 patients were enrolled in the study consecutively. The mean age of the patients was 70.1 (SD 15.2) years, with a sex ratio of 1:15. Nine hundred (60%) patients were from the public sector, while 600 (40%) patients were from the private sector. A total of 1298 (86.3%) patients received a conventional pacemaker and 75 (5%) patients received a biventricular pacemaker (CRT-P). Implantable cardioverter defibrillators were implanted in 127 (8.5%) patients. Of these patients, 45 (3%) underwent CRT-D implantation. Conclusions This study will establish the most extensive contemporary longitudinal cohort of patients undergoing CIED implantation in Tunisia, presenting a significant opportunity for real-world clinical epidemiology. It will address a crucial gap in the management of patients during the perioperative phase and follow-up, enabling the identification of individuals at particularly high risk of complications for optimal care. Trial Registration ClinicalTrials.gov NCT05361759; https://classic.clinicaltrials.gov/ct2/show/NCT05361759 International Registered Report Identifier (IRRID) RR1-10.2196/47525

We reported a case of pericardial agenesis discovered at the age of 60 during coronary artery bypass grafting surgery. However, this anomaly was not treated during the initial surgery. During the post-operatory period, the patient developed recurrent unilateral right pulmonary edema whenever assuming a semi-upright position. We hypothesized that the positional hemodynamic alterations in this patient were related to this rare congenital anomaly. The patient underwent reoperation, 48 hours later, with synthetic pericardial reconstruction and experienced an uneventful recovery during follow-up.

Peripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening condition. Due to the scarcity of epidemiological data in North Africa, we conducted this study to assess the outcomes of PPCM in our region. This monocentric retrospective cohort study involving all patients diagnosed with PPCM was conducted between January 2010 and December 2022. Twenty-seven PPCM patients, with a median age of 33 years (Interquartile range (IQR) = 9), were included. 52

Spontaneous coronary artery dissection (SCAD) is a serious pathology. The mechanism is poorly understood. The diagnosis has largely benefited from the development of intra-coronary imaging, but the treatment is still not consensual. We report the case of a 32-year-old woman with a history of aspirin allergy, who presented with an ST elevation acute coronary syndrome, one month after delivery. The coronary angiography showed a spiroid dissection of the right coronary and an ulceration of the left main coronary. We discovered a lesion in the left external iliac artery consistent with fibromuscular dysplasia, but renal arteries were spared. The management of this patient was challenging regarding allergy antecedents, the antiplatelet treatment should be extended for a long time, considering fibromuscular dysplasia. Even though hormonal impregnation during the peripartum period may explain SCAD, the systematic etiologic investigation was very contributive to adapting the management and the follow-up of the patient.