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Markos S, Nasir M, Ahmed M, Abebe S, Amogne MA, Tesfaye D, Mekonnen TS, Getachew YG. Assessment of Trend, Indication, Complications, and Outcomes of Pacemaker Implantation in Adult Patients at Tertiary Hospital of Ethiopia: Retrospective Follow Up Study. Int J Gen Med 2024; 17:93-103. [PMID: 38226183 PMCID: PMC10789569 DOI: 10.2147/ijgm.s448135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/10/2024] [Indexed: 01/17/2024] Open
Abstract
Background A pacemaker is a device implanted in the chest to help people with symptomatic bradycardia and life-threatening irregular rhythm. However, it is also associated with many complications. Therefore, this study evaluated pacemaker-related complications and factors associated with them, as there is little data on pacemaker-related complications in sub-Saharan Africa and Ethiopia. Methods The study was conducted on 118 patients over 18 years old who had pacemakers implanted between 2017 and 2022 at Tikur Anbessa Comprehensive Specialized Hospital in Addis Ababa, Ethiopia who were reviewed by the authors from September 2022 to December 2022. Sociodemographic factors, clinical characteristics, and complications data were extracted using a structured questionnaire by retrospective review of patient records. The chi-square test or Fisher's exact test was performed to evaluate factors associated with complications. Results The median age of patients was 60.5 years (IQR = 15 years), with men accounting for 50.8% of patients. Hypertension was the most common comorbidity (64.2%). Symptomatic grade 3 AV block was the most common indication (78.8%) for pacemaker implantation. With a mean follow-up of 3.92 ± 1.94 years, 15.3% of patients had complications. Pneumothorax, pocket site infection, and lead dislodgement were the most common complications occurring in 2.54% of patients each. Patient age during surgery (p-value = 0.02), patient gender (p-value = 0.04), pacemaker implanting team (p-value = 0.01), and adherence to follow-up (p-value = 0.04) are related to pacemakers-related complications. Conclusion Pacemaker implantation is associated with many complications. Pneumothorax, pacemaker pocket infection, and lead dislodgement were the most common complications. Patient age at pacemaker implantation, patient gender, pacemaker implanting team, and follow-up compliance were factors associated with pacemaker-related complications. Skill development through specialized training and compliance counseling may improve outcomes for patients who have complications related to pacemaker implanting team and poor adherence to follow.
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Affiliation(s)
- Sura Markos
- Internal Medicine Department, Hawassa University, Hawassa, Ethiopia
| | - Mohammed Nasir
- Pediatrics Department, Hawassa University, Hawassa, Ethiopia
| | - Muluken Ahmed
- Pediatrics Department, Arba Minch University, Arba Minch, Ethiopia
| | - Sintayehu Abebe
- Internal Medicine Department, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Demu Tesfaye
- Internal Medicine Department, Addis Ababa University, Addis Ababa, Ethiopia
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Makkar JS, Milasinovic G, Ching CK. Complementary role of governments, non-governmental organizations, industry, and medical societies in expanding bradycardia therapy access. Eur Heart J Suppl 2023; 25:H22-H26. [PMID: 38046889 PMCID: PMC10689899 DOI: 10.1093/eurheartjsupp/suad124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
As the aging population continues to grow, so has the incidence of cardiovascular diseases, including bradycardia, with much of the burden falling on low- and middle-income countries (LMICs). Pacemaker therapy remains the only guideline-recommended therapy for symptomatic bradycardia, but due to the cost and expertise required for pacemaker implants, patients in LMICs have less access to pacemaker therapies. However, with the concerted effort of organizations (governments, non-governmental organizations, industry, and medical societies) strides can continue to be made in improving access to care. Governments play a role in extending health coverage to its citizens and improving their physical and digital healthcare infrastructure. Non-governmental organizations promote access and awareness through charity and advocacy programs. Industries can continue innovating technology that is both affordable and accessible. Medical societies provide guidelines for treatment and necessary educational and networking opportunities for physicians who serve in LMICs. All of these organizations have individual responsibilities and goals in expanding access to bradycardia therapy, which can be more easily realized by their continued collaboration.
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Affiliation(s)
| | - Goran Milasinovic
- Referral Pacemaker Center, Clinical Center of Serbia, Koste Todorovica 8, 11000 Belgrade, Serbia
| | - Chi Keong Ching
- Department of Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
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Jeilan M, Varwani MH, Raqib A, Ozcan EE. Improving implant training for physicians and their teams in under-represented regions. Eur Heart J Suppl 2023; 25:H13-H21. [PMID: 38046887 PMCID: PMC10689900 DOI: 10.1093/eurheartjsupp/suad134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
The burden of cardiovascular disease is increasing globally, with low- and middle-income countries (LMICs) absorbing most of the burden while lacking the necessary healthcare infrastructure to combat the increase. In particular, the disparity in pacemaker implants between high-income countries and LMICs is glaring, partially spurned by reduced numbers of physicians and supporting staff who are trained in pacemaker implant technique. Herein, we will discuss current pacemaker implant training models, outline training frameworks that can be applied to underserved regions, and review adjunctive training techniques that can help supplement traditional training models in LMICs.
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Affiliation(s)
- Mohamed Jeilan
- Department of Cardiology, Aga Khan University Hospital, 3rd Parklands Rd, Nairobi, Kenya
| | - Mohamed Hasham Varwani
- Department of Cardiology, Aga Khan University Hospital, 3rd Parklands Rd, Nairobi, Kenya
| | - Abdul Raqib
- Department of Medicine, Hospital Serdang, Selangor, Malaysia
| | - Emin Evren Ozcan
- Department of Cardiology, Dokuz Eylul University, Balcova, Turkey
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Egas D, Rodriguez F, Jaswal A, Jeilan M, Milasinovic G, Al Fagih A. Burden of bradycardia and barriers to accessing bradycardia therapy in underserved countries. Eur Heart J Suppl 2023; 25:H1-H17. [PMID: 38046890 PMCID: PMC10689927 DOI: 10.1093/eurheartjsupp/suad125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Bradycardia, a condition characterized by an abnormally slow heart rate, poses significant challenges in terms of diagnosis and treatment. While it is a concern world-wide, low- and middle-income countries (LMICs) face substantial barriers in accessing appropriate bradycardia therapy. This article aims to explore the global aetiology and incidence of bradycardia, compare the prevalence and management of the condition in high-income countries versus LMICs, identify the key reasons behind the disparities in access to bradycardia therapy in LMICs, and emphasize the urgent need to address these disparities to ensure equitable healthcare on a global scale.
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Affiliation(s)
- Diego Egas
- Impulso Especialistas en Enfermedades Cardíacas, Department of Cardiology and Electrophysiology, Metropolitano Hospital of Quito, Ecuador, Medical Towers Metropolitano Hospital, Office 214, Quito 170135, Ecuador
- PUCE-TEC Technologies, Pontifical Catholic University of Ecuador, Quito 170143, Ecuador
| | - Francisco Rodriguez
- Impulso Especialistas en Enfermedades Cardíacas, Department of Cardiology and Electrophysiology, Metropolitano Hospital of Quito, Ecuador, Medical Towers Metropolitano Hospital, Office 214, Quito 170135, Ecuador
| | - Aparna Jaswal
- Department of Cardiac Pacing & Electropysiology, Fortis Escorts Heart Institute, New Delhi, Delhi 110025, India
| | - Mohamed Jeilan
- Section of Cardiology, Aga Khan University Hospital, Box 30270, Nairobi, Kenya
| | - Goran Milasinovic
- Referral Pacemaker Center, Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Ahmed Al Fagih
- Electrophysiology Division, Prince Sultan Cardiac Center, As Sulimaniyah, Riyadh 13213, Saudi Arabia
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Hugo E, Doubell A, Steyn J, Moses J. A retrospective audit of young adults who received permanent pacemakers at a teaching hospital in the Western Cape, South Africa. Front Cardiovasc Med 2023; 10:1235197. [PMID: 37840958 PMCID: PMC10570724 DOI: 10.3389/fcvm.2023.1235197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction While most pacemaker implantations occur in older individuals, younger patients also receive pacemakers. In these, degenerative conduction system disease is less likely to be the cause of atrioventricular block (AVB), with other diseases being more common. There is, however, a paucity of data on this group as well as on younger pacemaker recipients that have undergone pacemaker implantation for reasons other than AVB. The aim of this study was to perform an audit of young adult permanent pacemaker recipients. Method This was a retrospective record review, conducted in the Division of Cardiology at Tygerberg Hospital, Cape Town, South Africa. We included 169 adult patients between the ages of 18 and 60, who received permanent pacemakers between 2010 and 2020. A subgroup analysis of patients 55 years and younger was also performed. Results Third degree AVB was the most common indication for pacemaker implantation (n = 115; 68%), followed by high degree AVB (n = 23; 13.6%) and sick sinus syndrome (SSS; n = 14; 8.3%). A specific underlying cause for conduction system abnormalities was found in only 25.4% of patients (n = 43), with most of them being 55 years or younger (n = 32; 30.8% of patients ≤ 55 years). Specific causes that were identified included prosthetic valve implantation and/or valve repair (n = 14; 8.3%), myocardial infarction (n = 6; 3.6%), cardiac sarcoidosis (n = 5; 3.0%), coronary artery bypass grafting (n = 3; 1.8%), cardiomyopathy (n = 2; 1.2%), muscular dystrophy (n = 2; 1.2%), congenital heart disease (ventricular septal defect; atrioventricular septal defect; Tetralogy of Fallot; bicuspid aortic valve; n = 6; 3.6%), acute myocarditis (n = 1; 0.6%), atrial myxoma removal (n = 1; 0.6%), planned AV node ablation (n = 2; 1.2%), and following a previous stab in the chest (n = 1; 0.6%). Conclusion Given that the mean age of our study population was high, the low number of identified underlying causes in the whole cohort (≤60 years) may reflect some AVB due to age related degeneration of the conductions system in the patients 56 to 60 years age, but also raises the possibility that these patients may be less likely to be extensively investigated for an underlying cause than those ≤55 years, where diseases such as sarcoidosis were more readily confirmed. As access to advanced diagnostic tools improves, the percentage of young pacemaker recipients with an underlying cause identified may increase.
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Affiliation(s)
- Elrike Hugo
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
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Marijon E, Narayanan K, Smith K, Barra S, Basso C, Blom MT, Crotti L, D'Avila A, Deo R, Dumas F, Dzudie A, Farrugia A, Greeley K, Hindricks G, Hua W, Ingles J, Iwami T, Junttila J, Koster RW, Le Polain De Waroux JB, Olasveengen TM, Ong MEH, Papadakis M, Sasson C, Shin SD, Tse HF, Tseng Z, Van Der Werf C, Folke F, Albert CM, Winkel BG. The Lancet Commission to reduce the global burden of sudden cardiac death: a call for multidisciplinary action. Lancet 2023; 402:883-936. [PMID: 37647926 DOI: 10.1016/s0140-6736(23)00875-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 04/13/2023] [Accepted: 04/25/2023] [Indexed: 09/01/2023]
Abstract
Despite major advancements in cardiovascular medicine, sudden cardiac death (SCD) continues to be an enormous medical and societal challenge, claiming millions of lives every year. Efforts to prevent SCD are hampered by imperfect risk prediction and inadequate solutions to specifically address arrhythmogenesis. Although resuscitation strategies have witnessed substantial evolution, there is a need to strengthen the organisation of community interventions and emergency medical systems across varied locations and health-care structures. With all the technological and medical advances of the 21st century, the fact that survival from sudden cardiac arrest (SCA) remains lower than 10% in most parts of the world is unacceptable. Recognising this urgent need, the Lancet Commission on SCD was constituted, bringing together 30 international experts in varied disciplines. Consistent progress in tackling SCD will require a completely revamped approach to SCD prevention, with wide-sweeping policy changes that will empower the development of both governmental and community-based programmes to maximise survival from SCA, and to comprehensively attend to survivors and decedents' families after the event. International collaborative efforts that maximally leverage and connect the expertise of various research organisations will need to be prioritised to properly address identified gaps. The Commission places substantial emphasis on the need to develop a multidisciplinary strategy that encompasses all aspects of SCD prevention and treatment. The Commission provides a critical assessment of the current scientific efforts in the field, and puts forth key recommendations to challenge, activate, and intensify efforts by both the scientific and global community with new directions, research, and innovation to reduce the burden of SCD worldwide.
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Affiliation(s)
- Eloi Marijon
- Division of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France; Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France.
| | - Kumar Narayanan
- Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France; Medicover Hospitals, Hyderabad, India
| | - Karen Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Silverchain Group, Melbourne, VIC, Australia
| | - Sérgio Barra
- Department of Cardiology, Hospital da Luz Arrábida, Vila Nova de Gaia, Portugal
| | - Cristina Basso
- Cardiovascular Pathology Unit-Azienda Ospedaliera and Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Marieke T Blom
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Lia Crotti
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Cardiomyopathy Unit and Laboratory of Cardiovascular Genetics, Department of Cardiology, Milan, Italy
| | - Andre D'Avila
- Department of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Cardiology, Hospital SOS Cardio, Santa Catarina, Brazil
| | - Rajat Deo
- Department of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Florence Dumas
- Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France; Emergency Department, Cochin Hospital, Paris, France
| | - Anastase Dzudie
- Cardiology and Cardiac Arrhythmia Unit, Department of Internal Medicine, DoualaGeneral Hospital, Douala, Cameroon; Yaounde Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Audrey Farrugia
- Hôpitaux Universitaires de Strasbourg, France, Strasbourg, France
| | - Kaitlyn Greeley
- Division of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France; Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France
| | | | - Wei Hua
- Cardiac Arrhythmia Center, FuWai Hospital, Beijing, China
| | - Jodie Ingles
- Centre for Population Genomics, Garvan Institute of Medical Research and UNSW Sydney, Sydney, NSW, Australia
| | - Taku Iwami
- Kyoto University Health Service, Kyoto, Japan
| | - Juhani Junttila
- MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Rudolph W Koster
- Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Theresa M Olasveengen
- Department of Anesthesia and Intensive Care Medicine, Oslo University Hospital and Institute of Clinical Medicine, Oslo, Norway
| | - Marcus E H Ong
- Singapore General Hospital, Duke-NUS Medical School, Singapore
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group, St George's University of London, London, UK
| | | | - Sang Do Shin
- Department of Emergency Medicine at the Seoul National University College of Medicine, Seoul, South Korea
| | - Hung-Fat Tse
- University of Hong Kong, School of Clinical Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region, China; Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Zian Tseng
- Division of Cardiology, UCSF Health, University of California, San Francisco Medical Center, San Francisco, California
| | - Christian Van Der Werf
- University of Amsterdam, Heart Center, Amsterdam, Netherlands; Department of Clinical and Experimental Cardiology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christine M Albert
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Bo Gregers Winkel
- Department of Cardiology, University Hospital Copenhagen, Rigshospitalet, Copenhagen, Denmark
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Mustafa B, Butt H, Khan MS, Rashid S, Noor TA, Alam S, Ashraf W, Malik J. Social determinants of pacemaker reuse among patients and family members in Pakistan. Expert Rev Cardiovasc Ther 2023; 21:145-150. [PMID: 36745028 DOI: 10.1080/14779072.2023.2177636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This survey aimed to quantify the opinions of CIED reuse among patients and family members in Pakistan and to identify the social determinants which may predict these views. METHODS A questionnaire formulating attitudes toward PPM reuse was administered to patients and family members at cardiology institutes in Pakistan from 1 July 2022 to 30 September 2022. The eligibility criteria (age > 18 years; inline for PPM placement) were taken into account and incomplete responses were excluded from the final analysis. RESULTS A total of 9,246 participants recorded their responses, of which 7,152 (78.16%) accepted pre-used PPMs. The lower social class had more PPM reuse acceptance rate than the middle and upper class (92.72% vs. 60.52% vs. 35.38%), respectively. Age ≥ 65 (OR(95%CI): 0.68 (0.41-0.99); P-value = 0.023), male gender (OR(95%CI): 0.55 (0.35-0.72), P-value = 0.016), unemployment (OR(95%CI): 0.47 (0.25-0.64); P-value = 0.007), poor health status (OR(95%CI): 0.72 (0.53-0.92); P-value = 0.041), and lower social class (OR(95%CI): 0.36 (0.28-0.53); P-value = 0.003) were social determinants of PPM reuse acceptance. CONCLUSION Patients and their family members endorse the concept of PPM reuse in Pakistan who cannot afford new devices.
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Affiliation(s)
- Bilal Mustafa
- Department of Cardiology, Akbar Niazi Teaching Hospital, Islamabad, Pakistan
| | - Hamza Butt
- Department of Medicine, Services Hospital, Lahore, Pakistan
| | | | - Sarim Rashid
- Department of General Surgery, East Lancashire NHS Trust, Lancashire, UK
| | | | - Shafiq Alam
- Department of Cardiology, Mardan Medical Complex, Mardan, Pakistan
| | - Waheed Ashraf
- Department of Cardiology, Abbas Institute of Medical Sciences, Muzaffarabad, Pakistan
| | - Jahanzeb Malik
- Department of Clinical Electrophysiology, Cardiovascular Analytics Group, Hong Kong, China
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Abstract
Delivery of comprehensive arrhythmia care requires the simultaneous presence of many resources. These include complex hospital infrastructure, expensive implantable equipment, and expert personnel. In many low- and middle-income countries (LMICs), at least 1 of these components is often missing, resulting in a gap between the demand for arrhythmia care and the capacity to supply care. In addition to this treatment gap, there exists a training gap, as many clinicians in LMICs have limited access to formal training in cardiac electrophysiology. Given the progressive increase in the burden of cardiovascular diseases in LMICs, these patient care and clinical training gaps will widen unless further actions are taken to build capacity. Several strategies for building arrhythmia care capacity in LMICs have been described. Medical missions can provide donations of both equipment and clinical expertise but are only intermittently present and therefore are not optimized to provide the longitudinal support needed to create self-sustaining infrastructure. Use of donated or reprocessed equipment (eg, cardiac implantable electronic devices) can reduce procedural costs but does not address the need for infrastructure, including diagnostics and expert personnel. Collaborative efforts involving multiple stakeholders (eg, professional organizations, government agencies, hospitals, and educational institutions) have the potential to provide longitudinal support of both patient care and clinician education in LMICs.
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Affiliation(s)
- Zain Sharif
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts,Cardiology Service, Hermitage Clinic, Fonthill, Ireland
| | - Leon M. Ptaszek
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts,Address reprint requests and correspondence: Dr Leon M. Ptaszek, Cardiac Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street (GRB 825), Boston, MA 02114.
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9
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Adoubi KA, Coulibaly I, Ndjessan JJ, Gnaba A, Tano M, Tro G, Kendja F. [Characteristic and evolution of pacemaker complications in a Subsaharan Africa Heart Centre]. Ann Cardiol Angeiol (Paris) 2021; 71:21-26. [PMID: 33640148 DOI: 10.1016/j.ancard.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
AIM OF THE STUDY The working environment and the low rate of pacemaker insertions increase the risk of complications in sub-Saharan Africa. The objective of our work was to assess the impact of specific preventive measures on these complications over the long term. PATIENT AND METHODS We conducted a retrospective study of all pacemaker implantations from June 2006 to June 2016 at the Abidjan Heart Institute. We evaluated the incidence of pacemaker complications, their risks factors and their impact on the overall prognosis of patients. RESULTS Three hundred and two procedures were performed in 286 patients (49% male, mean age: 67±12 years), with a predominance of primary implantation (82.8%) of single-chamber ventricular pacemakers (66.6%). Twenty-five major complications (8.27%) and 14 minor (4.6%) occurred with a predominance of lead displacements (3.64%). The major complications were favored by the subclavian approach (P=0.018; OR=2.34; 95% CI [1.16-4.75]) and intraoperative incidents (P=0.02; OR=2.17; 95% CI [1.16-4.75]. The preventive measures taken made it possible to achieve a significant (P=0.017) and linear (P=0.009) reduction of these complications, with no effect the patients prognosis (Log-Rank=0.217; P=0.64). CONCLUSION Quality cardiac stimulation is possible in Sub-Saharan Africa with preventive measures adapted to the environment.
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Affiliation(s)
- K A Adoubi
- Institut de cardiologie d'Abidjan, BP V206, Abidjan, Cote d'Ivoire; Université de Bouaké, Bouaké, Cote d'Ivoire.
| | - I Coulibaly
- Institut de cardiologie d'Abidjan, BP V206, Abidjan, Cote d'Ivoire
| | - J J Ndjessan
- Institut de cardiologie d'Abidjan, BP V206, Abidjan, Cote d'Ivoire
| | - A Gnaba
- Université de Bouaké, Bouaké, Cote d'Ivoire
| | - M Tano
- Institut de cardiologie d'Abidjan, BP V206, Abidjan, Cote d'Ivoire
| | - G Tro
- Institut de cardiologie d'Abidjan, BP V206, Abidjan, Cote d'Ivoire
| | - F Kendja
- Institut de cardiologie d'Abidjan, BP V206, Abidjan, Cote d'Ivoire
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Dzudie A, Barche B, Mouliom S, Nouko A, Fogue R, Ndjebet J, Makoh SA, Abah J, Djomou A, Nzali A, Nkoke C, Kamdem F, Kingue S, Sliwa K, Kengne AP. Resting heart rate predicts all-cause mortality in sub-Saharan African patients with heart failure: a prospective analysis from the Douala Heart failure registry (Do-HF). Cardiovasc Diagn Ther 2021; 11:111-119. [PMID: 33708483 DOI: 10.21037/cdt-20-785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Higher resting heart rate (HR) is associated with mortality amongst Caucasians with heart failure (HF), but its significance has yet to be established in sub-Saharan Africans in whom HF differs in terms of characteristics and etiologies. We assessed the association of HR with all-cause mortality in patients with HF in sub-Saharan Africa. Methods The Douala HF registry (Do-HF) is an ongoing prospective data collection on patients with HF receiving care at four cardiac referral services in Douala, Cameroon. Patients included in this report were followed-up for 12 months from their index admission, for all-cause mortality. We used Cox-regression analysis to study the association of HR with all-cause mortality during follow-up. Results Of 347 patients included, 343 (98.8%) completed follow-up. The mean age was 64±14 years, 176 (50.7%) were female, and median admission HR was 85 bpm. During a median follow-up of 12 months, 78 (22.7%) patients died. Mortality increased steadily with HR increase and ranged from 12.2% in the lower quartile of HR (≤69 bpm) to 34.1% in the upper quartile of HR (>100 bpm). Hazard ratio of 12-month death per 10 bpm higher HR was 1.16 (1.04-1.29), with consistent effects across most subgroups, but a higher effect in participants with hypertension vs. those without (interaction P=0.044). Conclusions HR was independently associated with increased risk of all-cause mortality in this study, particularly among participants with hypertension. The implication of this finding for risk prediction or reduction should be actively investigated.
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Affiliation(s)
- Anastase Dzudie
- Cardiology and Cardiac Pacing Unit, Douala General Hospital, Douala, Cameroon.,Clinical Research Education Networking & Consultancy (CRENC), Douala, Cameroon.,Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Blaise Barche
- Clinical Research Education Networking & Consultancy (CRENC), Douala, Cameroon
| | - Sidick Mouliom
- Cardiology and Cardiac Pacing Unit, Douala General Hospital, Douala, Cameroon
| | - Ariane Nouko
- Clinical Research Education Networking & Consultancy (CRENC), Douala, Cameroon
| | - Raissa Fogue
- Clinical Research Education Networking & Consultancy (CRENC), Douala, Cameroon
| | | | | | | | | | - Archange Nzali
- Clinical Research Education Networking & Consultancy (CRENC), Douala, Cameroon
| | - Clovis Nkoke
- Clinical Research Education Networking & Consultancy (CRENC), Douala, Cameroon
| | - Felicite Kamdem
- Cardiology and Cardiac Pacing Unit, Douala General Hospital, Douala, Cameroon
| | - Samuel Kingue
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.,Yaounde General Hospital, Cameroon
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa and the Institute of Infectious Disease and Molecular Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Andre Pascal Kengne
- Department of Medicine, University of Cape Town, Cape Town, South Africa.,Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
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11
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Kane A, Adoubi A, Niakara A, Houenassi M, Mbaye A, Sarr SA, Tabane A, Kane A, Ba SA, Moustakhfir A, Defaye P, Kouakam C. Diplôme universitaire de stimulation cardiaque en Afrique subsaharienne : un bel exemple de coopération Nord-Sud et Sud-Sud. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.lpmfor.2020.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dzudie A, Ngongang Ouankou C, Nganhyim L, Mouliom S, Ba H, Kamdem F, Ndjebet J, Nzali A, Tantchou C, Nkoke C, Barche B, Abanda M, Metogo Mbengono UA, Hentchoya R, Petipe Nkappe C, Ouankou M, Kouam Kouam C, Mintom P, Boombhi J, Kuate Mfeukeu L, Ngatchou W, Kingue S, Ngowe Ngowe M. Long-term prognosis of patients with permanent cardiac pacemaker indication in three referral cardiac centers in Cameroon: Insights from the National pacemaker registry. Ann Cardiol Angeiol (Paris) 2020; 70:18-24. [PMID: 32778387 DOI: 10.1016/j.ancard.2020.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 07/21/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND There is evidence that cardiac pacemakers improve symptoms and quality of life in patients with severe bradycardia. Globally, the number of pacemaker implantations is on the rise. However, the associated high-cost limits pacemaker's accessibility in low resource settings. This study aimed to investigate access to pacemakers and the long-term outcome of patients requiring a pacemaker. METHOD We conducted a cohort study in 03 health care structures in Cameroon. Participants aged at least 18 years with indication for a permanent pacemaker between January 2010 and May 2016 were included. Clinical profile, electrocardiography, pacemaker implantation parameters were recorded. Long-term survival was studied by event-free analysis using the Kaplan-Meier method. RESULTS In total, 147 participants (mean age 67.7±13.7 years, female 58.5%) were included. Fatigue (78.7%), dyspnoea (77.2%), dizziness (47.1%) and palpitations (40.4%) were the main symptoms while syncope was present in 35.7% of patients. The main indication for cardiac pacemaker was atrioventricular block (85.3%). Forty (27.2%) could not be implanted with 34 (85%) of participants highlighting cost of intervention as main reason. VVIR was the main mode of stimulation (70.5%). Of 125 patients in which follow-up was ascertained, 17(13.5%) died after a median survival time of 2.8 years post diagnosis [IQR: 1.8-4.2]. The survival curve was better in participants with a pacemaker with a Hazard ratio of 2.7 [CI: 1.0-7.3, P=0.045]. CONCLUSION Our patients with severe heart blocks presented late and more than a quarter did not have access to pacemaker but its implantation multiplied the survival rate by 2.7 times at approximately 3 years post diagnosis. Improving early detection of heart blocks and access to cardiac pacing to reduce mortality shall be a key future priority.
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Affiliation(s)
- A Dzudie
- Cardiology and Cardiac Pacing Unit, Douala General Hospital, P.O Box 4856 Douala, Cameroon; Clinical Research Education Networking & Consultancy (CRENC), Douala, Cameroon; Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.
| | | | - L Nganhyim
- Clinical Research Education Networking & Consultancy (CRENC), Douala, Cameroon
| | - S Mouliom
- Cardiology and Cardiac Pacing Unit, Douala General Hospital, P.O Box 4856 Douala, Cameroon
| | - H Ba
- Faculty of Medicine and Phramaceutical Sciences, University of Douala, Douala, Cameroon
| | - F Kamdem
- Faculty of Medicine and Phramaceutical Sciences, University of Douala, Douala, Cameroon
| | - J Ndjebet
- Douala Cardiovascular Centre, Douala, Cameroon
| | - A Nzali
- Deido District Hospital, Douala, Cameroon
| | | | - C Nkoke
- Clinical Research Education Networking & Consultancy (CRENC), Douala, Cameroon; Buea Regional Hospital, Buea, Cameroon
| | - B Barche
- Clinical Research Education Networking & Consultancy (CRENC), Douala, Cameroon; Faculty of Medicine and Phramaceutical Sciences, University of Douala, Douala, Cameroon; Douala Cardiovascular Centre, Douala, Cameroon
| | - M Abanda
- Clinical Research Education Networking & Consultancy (CRENC), Douala, Cameroon
| | - U A Metogo Mbengono
- Faculty of Medicine and Phramaceutical Sciences, University of Douala, Douala, Cameroon; Intensive Care Unit, Douala General Hospital, Douala, Cameroon
| | - R Hentchoya
- Intensive Care Unit, Douala General Hospital, Douala, Cameroon
| | - C Petipe Nkappe
- Buea Regional Hospital, Buea, Cameroon; Guidelines Advisory Network, Paris, France
| | - M Ouankou
- Cardiology and Medical Centre, Yaounde, Cameroon
| | - C Kouam Kouam
- Service of internal medicine and cardiology, Bafoussam regional hospital, Bafoussam, Cameroon
| | - P Mintom
- Faculty of Medicine and Phramaceutical Sciences, University of Douala, Douala, Cameroon; Deido District Hospital, Douala, Cameroon
| | - J Boombhi
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - L Kuate Mfeukeu
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - W Ngatchou
- Faculty of Medicine and Phramaceutical Sciences, University of Douala, Douala, Cameroon
| | - S Kingue
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - M Ngowe Ngowe
- Faculty of Medicine and Phramaceutical Sciences, University of Douala, Douala, Cameroon
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Rwebembera J, Jeilan M, Ajijola OA, Talle M, Sani MU, Karaye KM, Yuyun MF, Nel G, Akinyi L, Subahi S, Aboulmaaty M, Sogade F, Aoudia Y, Mbakwem A, Tantchou C, Salim M, Tayebjee MH, Poku JW, Vezi B, Kaviraj B, Ngantcha M, Chin A, Bonny A. Cardiac Pacing Training in Africa. J Am Coll Cardiol 2020; 76:465-472. [DOI: 10.1016/j.jacc.2020.04.079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 10/23/2022]
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