Feasibility and safety of interventional electrophysiology and catheter ablation in the South African public sector: Challenges and opportunities for comprehensive cardiac electrophysiology in South Africa

Abstract

Aims The spectrum and outcomes of catheter ablation procedures performed in South Africa are unknown, and therefore, the feasibility of interventional electrophysiology in the South African public sector is undetermined. Methods and Results This study was a retrospective review of all patients that underwent invasive electrophysiology procedures and catheter ablation at Groote Schuur Hospital (GSH) and the University of Cape Town Private Academic Hospital (UCTPAH) between 01 January 2013 and 31 December 2020. One thousand one hundred eighty‐six invasive electrophysiology procedures were performed during the study period. Of these were 1102 catheter ablation procedures. There were 76 redo catheter ablation procedures, predominantly for atrial fibrillation (AF), which accounted for 39% (30/76) of the repeat procedures. There were only 0.8% (9/1102) catheter ablation related complications which were mostly access related. Atrial fibrillation accounted for most of the ablation procedures, 28.9% (318/1102); these were mainly performed at UCTPAH than at GSH, 300 vs 18 p < .0001. Cavotricuspid isthmus (CTI) dependent atrial flutter ablation was the second most commonly performed catheter ablation procedure, accounting for 21.6% (238/1102) of the catheter ablation procedures. More CTI dependent atrial flutter ablations were performed at GSH than a UCTPAH, 156 vs 82 p < .0001. The overall success rate of catheter ablation was 92%. Conclusion A broad spectrum of catheter ablation procedures was performed with a high success rate and limited complications, thus demonstrating the feasibility of safe cardiac electrophysiology and catheter ablation in the South African public sector.

Cryoballoon ablation for atrial fibrillation in South Africa: One-year outcome from the Cryo Global Registry

“…In fact, the number of CA procedures overall has steadily increased in the past decade. [6] SA is the only country in the sub-Saharan African region to perform complex cardiac ablations requiring three-dimensional (3D) mapping and trans-septal puncture. [7] Mkoko et al [6] reported that AF ablation accounted for most of the CA cases, and radiofrequency ablation (RFA) was more commonly used than cryoballoon ablation (CBA; 94.7% v. 5.3%), respectively.…”

“…[6] SA is the only country in the sub-Saharan African region to perform complex cardiac ablations requiring three-dimensional (3D) mapping and trans-septal puncture. [7] Mkoko et al [6] reported that AF ablation accounted for most of the CA cases, and radiofrequency ablation (RFA) was more commonly used than cryoballoon ablation (CBA; 94.7% v. 5.3%), respectively. CBA is a 'singleshot' anatomical ablation approach to pulmonary vein isolation (PVI), not requiring 3D mapping.…”