Cardiac pacing challenge in Sub-Saharan Africa environnement: experience of the Cardiology Department of Teaching Hospital Aristide Le Dantec in Dakar

Abstract

Background Cardiac pacing is a growing activity in Sub-Saharan Africa. There is little data on the characteristics of this interventional treatment in our regions. The goal was to evaluate the results of cardiac pacing in a referral service in sub-Saharan Africa. Methods We carried out a twelve-year retrospective study (from January 1st, 2004 to December 31st, 2015) in the Cardiology Department of Aristide Le Dantec University Hospital. This work included all patients who received definitive cardiac pacing during the study period and followed up in the service. Results In total we included 606 patients. There was a growing trend in activity with a peak in 2015 (17%). The average age was 70.6 ± 12.03 years. Some patients (15.4%) came from the subregion. The patients were mostly of medium socio-economic level (53%); 14% were of low socio-economic level. Patients were symptomatic in 85% of cases (37.4% syncope). The indications were dominated by complete atrioventricular block (81.5%); sinus dysfunction accounted for 1.9% of them. A temporary pacemaker was used in 60% of cases for an average duration of 5.1 ± 6.3 days. Antibiotics, local anesthesia and analgesics were used in all cases. Implanted pacemakers were single chamber in 56% of cases and double chamber in 44% of cases. In 39 patients (6.4%), the pacemaker was a « re-used » one. The atrial leads were most often placed in a lateral position (94.5%). The ventricular ones were predominantly tined (95.7%) and more often located at the apical level. Complications were noted in 24 patients (3.9%), dominated by devices externalizations and infections, which together accounted for 2.7% of cases. The number of people in the cathlab was significantly higher and the duration of the temporary pacemaker was longer for patients who had a complication. There was no significant difference depending on the type of pacemaker used (new or reused). Seven (7) in hospital death cases were reported. Conclusion Cardiac pacing is a growing activity in Dakar.

Cardiac surgery in East Africa: a profile of cases and referral to physiotherapy

“…The present study has shown that, patients waited on average 38.35 days for surgery as opposed to an average of 8 days reported in Senegal 30 . The longer pre-operatively stay of the majority of patients in this study can be associated to the lack of consumables and limited number of cardiothoracic surgeons in the unit.…”

Assessment of Trend, Indication, Complications, and Outcomes of Pacemaker Implantation in Adult Patients at Tertiary Hospital of Ethiopia: Retrospective Follow Up Study

“…Pneumothorax occurred in 2.54% of study participants in our study, which is about in line with other studies’ findings. 8 , 15 , 16 , 18–22 When compared to individual studies, it is greater than those conducted in Taiwan (0.6%), the United States (1.3%), the United States (1.5%), Denmark (0.9%), the Netherlands (2.24%), Norway (2.8%), Cameroon (1.6%), and Senegal (0.6%), but lower than those made in Spain (3.9%). 8 , 15 , 16 , 18–22 This variation in pneumothorax magnitude between studies may be explained by variations in professional experience among centres, variations of venous access for implantation, and the inclusion of patients with CRT and ICD in quantifying the pneumothorax rate in some of these researches.…”

“…In this study, lead dislodgment occurred in 2.5% of patients; this rate was higher than that of the United States (2.4%), Poland (2.4%), the Netherlands (4.9%), Iraq (0.25%), and Senegal (0.6%), but lower than that of Kenya. 9 , 11 , 13 , 15 , 23 , 25 The use of various fixation types and differences in follow-up duration in the studies can account for this disparity in lead dislodgement rate.…”

“…Our study found a death rate that was higher than studies conducted in Australia (0.73%), Iraq (0%), the USA (0.08%), and Kenya (0.0%), but lower than those conducted in Senegal (1.2%), Spain (5.2%), and France (3.9%). 9 , 10 , 13 , 15 , 20 , 23 , 33 …”

“…We identified also the most common pacemaker-related complications as Studies that looked at the magnitude of complications related to pacemaker implantation found that the rate of complications ranged from 3.6% to 21.6%. [8][9][10][11][12][13][14][15][16][17] Variations in patient sociodemographic factors among studies, patient volumes, and Centre-to-Centre differences in experience levels may all account for this heterogeneity in the rate of complications. In comparison to studies conducted in Norway, Australia, Germany, the United States, Iraq, Senegal, Cameroon, and Ghana, which showed complication rates of 12%, 7.2%, 3%, 4.2%, 4.25%, 3.9%, 9.7%, and 7%, respectively, this study's complication rate of 15.3% is greater.…”