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

Adama Kane,Alioune Tabane,Mouhamadou Bamba Ndiaye,Aliou Alassane Ngaidé,Serigne Mor Beye,Malick Bodian,Momar Dioum,Abdoul Kane,Kana Babaka,Maboury Diao,Simon Antoine Sarr,Juliette Valerie Danièle Ndobo,Fatou Aw,Alassane Mbaye,Serigne Abdou Ba

doi:10.1186/s12872-019-1176-2

Adama Kane, Alioune Tabane + Show 13 more

Open Access

https://doi.org/10.1186/s12872-019-1176-2

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Abstract

BackgroundCardiac 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.MethodsWe 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.ResultsIn 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.ConclusionCardiac pacing is a growing activity in Dakar.

Highlights

Cardiac pacing is a growing activity in Sub-Saharan Africa
Pacing is a lifesaving treatment during cardiac conduction disorders
Indications were dominated by complete atrioventricular block (AV block) (81.5%)

Summary

Introduction

Cardiac pacing is a growing activity in Sub-Saharan Africa. The goal was to evaluate the results of cardiac pacing in a referral service in sub-Saharan Africa. Pacing is a lifesaving treatment during cardiac conduction disorders. Patients with these disorders are exposed to heart failure and to sudden death due to too long asystole or ventricular arrhythmia resulting from significant bradycardia [1]. The progression is impeded, on one hand, by the high cost of cardiac implantable electronic devices CIED [2] and the lack of medical insurance for patients, and on the other hand, by the limited or nonexistent human resources depending on the country [3]. Few data are available for cardiac pacing in Sub-Saharan Africa

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