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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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Yuyun MF, Bonny A, Ng GA, Sliwa K, Kengne AP, Chin A, Mocumbi AO, Ngantcha M, Ajijola OA, Bukhman G. A Systematic Review of the Spectrum of Cardiac Arrhythmias in Sub-Saharan Africa. Glob Heart 2020; 15:37. [PMID: 32923331 PMCID: PMC7413135 DOI: 10.5334/gh.808] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 12/15/2022] Open
Abstract
Major structural cardiovascular diseases are associated with cardiac arrhythmias, but their full spectrum remains unknown in sub-Saharan Africa (SSA), which we addressed in this systematic review. Atrial fibrillation/atrial flutter (AF/AFL) prevalence is 16-22% in heart failure, 10-28% in rheumatic heart disease, 3-7% in cardiology admissions, but <1% in the general population. Use of oral anticoagulation is heterogenous (9-79%) across SSA. The epidemiology of sudden cardiac arrest/death is less characterized in SSA. Cardiopulmonary resuscitation is challenging, owing to low awareness and lack of equipment for life-support. About 18% of SSA countries have no cardiac implantable electronic devices services, leaving hundreds of millions of people without any access to treatment for advanced bradyarrhythmias, and implant rates are more than 200-fold lower than in the western world. Management of tachyarrhythmias is largely non-invasive (about 80% AF/AFL via rate-controlled strategy only), as electrophysiological study and catheter ablation centers are almost non-existent in most countries. Highlights - Atrial fibrillation/flutter prevalence is 16-22% in heart failure, 10-28% in rheumatic heart disease, 3-7% in cardiology admissions, and <1% in the general population in sub-Saharan Africa (SSA).- Rates of oral anticoagulation use for CHA2DS2VASC score ≥2 are very diverse (9-79%) across SSA countries.- Data on sudden cardiac arrest are scant in SSA with low cardiopulmonary resuscitation awareness.- Low rates of cardiac implantable electronic devices insertions and rarity of invasive arrhythmia treatment centers are seen in SSA, relative to the high-income countries.
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Affiliation(s)
- Matthew F. Yuyun
- Department of Medicine, Harvard Medical School, Boston, US
- Cardiology and Vascular Medicine Service, VA Boston Healthcare System, Boston, US
| | - Aimé Bonny
- District Hospital Bonassama, Douala/University of Douala, CM
- Homeland Heart Centre, Douala, CM
- Centre Hospitalier Montfermeil, Unité de Rythmologie, Montfermeil, FR
| | - G. André Ng
- National Institute for Health Research Leicester Biomedical Research Centre, Department of Cardiovascular Sciences, University of Leicester, UK
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, ZA
| | - Andre Pascal Kengne
- South African Medical Research Council and Department of Medicine, University of Cape Town, ZA
| | - Ashley Chin
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, ZA
| | - Ana Olga Mocumbi
- Instituto Nacional de Saúde and Universidade Eduardo Mondlane, Maputo, MZ
| | | | | | - Gene Bukhman
- Department of Medicine, Harvard Medical School, Boston, US
- Division of Cardiovascular Medicine and Division of Global Health Equity, Brigham and Women’s Hospital, Boston, US
- Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, US
- NCD Synergies project, Partners In Health, Boston, US
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Abstract
Animal models are invaluable tools for translational research, allowing investigators to recapitulate observed clinical scenarios within the laboratory that share attributes with human disease. Here, we describe a mouse model of post-arthroplasty Staphylococcus epidermidis joint infection which mimics human disease and may be utilized to explore the complex series of events during staphylococcal implant-associated infections by identifying key immunological, bacterial, and/or therapeutic mechanisms relevant to these persistent infections.
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