16-38: Permanent pacing for complete atrioventricular block in central Africa

Abstract

The goal of the study was to investigate the occurrence of complete atrio-ventricular block, its management and follow-up of patients from the 10th October 2009 till 9th October 2015 in the cardiac centre Shisong, located in Cameroon, Central Africa. Patients and methods: 123 patients were recruited during the 10th October 2009 till the 10th October 2015 suffering from complete atrio-ventricular block. The admission files and outpatient department booklets were reviewed. The follow up of patients was done for five years. Results: 123 patients were recruited in study, 59% n = 73 were male and 41% n = 50 were female. The mean age at recruitment was 65 ± 12 years old. Patients were presenting with shortness of breath on physical exertion (95%, n = 115), and fatigue (65%, n = 80). As comorbidities, we had hypertension (61%, n = 75), diabetes mellitus type 2 (1%, n = 5), - polyarthrosis and arthritis . Crisis of loss of consciousness were present in (21%, n = 26). Only 63 (51%) patients benefited from a pace maker, 42 (66%) male and 21 (34%) female. Dual chambered pace makers were implanted in 58 (92%) patients and single chambered in 5 (9%) cases, due to the cost, single chambered pace makers being less expensive. The intra-operative parameters were: atrial threshold: 0,375 ±0,2 V atrial sensing: 2,1 ± 0,5 mV, impedance of the atrial lead: 662 ± 7 Ohm, ventricular threshold: 0,75 ±0,1 V, ventricular sensing: 9,6 ± 0,7 mV impedance of the ventricular lead: 682 ± 6 Ohm . We had during the 5 years follow-up a death rate of 4% (n = 3) in the paced group due complications of comorbidities and in the non-paced group it was: 84% (n = 52) due to complications of comorbidities and the heart conduction pathology. Patients of the non-paced group were having low quality of life marked by the exacerbation of the symptoms of the disease. Conclusion: Pacing in general and in patients with complete atrio-ventricular block is done with success in central Africa, mainly in Cameroon. Financial limitation is the main factor depriving patients from the procedure.