CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 6, November/December 2011
348
AFRICA
Medical devices in cardiovascular medicine
Global PANORAMA study collects largest database on 10 000 patients from the Middle East and Africa
Medtronic in the Middle East and Africa
area has recently announced that the
PANORAMA study has successfully
enrolled its ten thousandth patient. This
study is the first in the world to include
more than 31% of its patient population
from the Middle East and African region
(MEA), and more specifically from
20 different enrolling centres in South
Africa, Saudi Arabia, Kuwait and Turkey.
This is expected to allow healthcare
practitioners in the field to better assess
and understand patient characteristics
specific to our region and help evaluate
whether treatment required for patients
in the MEA should be different from
that in other countries, especially Europe
and the USA. To date, there is very
little evidence available to shed light on
regional differences in practice patterns,
but PANORAMA is expected to provide
the missing data.
‘The PANORMA study is an important
international registry; yet, it will be our
local data that will be unique’, comment-
ed Prof A Okreglicki, director of the
Interventional Cardiac Electrophysiology
Laboratory at the Groote Schuur Hospital
in Cape Town. Some of the first results
from this study were presented at the
recent SA Heart meeting held in East
London.
Unitas Hospital, Gauteng sheds
light on South African responder
patterns in patients undergoing
cardiac resynchronisation therapy
This study of mainly male patients (22 in
total), average age 65 years, has shown an
overall significant improvement in ejec-
tion fraction (EF) in patients who received
cardiac resynchronisation therapy (CRT).
1
The majority were normal responders
(improvement in left ventricular EF in
the range of 3–5%) but the percentage
of hyper-responders (13.6%) and super-
responders (18%) was higher than in
other previously described studies. The
authors noted this might be due to the
highly selected population and the initial
broad QRS duration, a mean of 141.4 ms,
which improved on average by 19 ms.
Pacemaker implantation in South
Africa: patient demographics
and implant data
In this first overview of 904 patients from
13 hospitals in South Africa, of which 12
were in the private sector, differences in
approach between a well-resourced public
hospital (Groote Schuur Hospital) and the
private sector were noted.
2
In common were baseline character-
istics where the patients were mainly
Caucasian (85%), 57% male and aged 68
±
16 years; 20% were in atrial fibrillation
and 23% had heart failure.
The primary indication at enrolment
varied, with atrio-ventricular block being
more common in the public sector (70
vs 19%), and sinus node disease being
more common in the private sector (67
vs 20%).
Use of devices also differed, with one-
chamber devices being more commonly
used in the public sector and two- and
three-chamber devices being used in the
private sector.
Focus on baseline characteristics
and demographic differences in
ICD patients in the Gulf region
(Saudi Arabia and Kuwait)
Between May 2005 and November 2010,
610 patients (age 58.7
±
14.6 years,
79.7% male) were implanted with an ICD
in one centre in Kuwait and six centres
in Saudi Arabia. The data were compared
with 1 205 patients in the rest of the world
(age 59.1
±
15.0 years, 82.3% male).
PANORAMA shows that the popu-
lation from the Gulf region has some
specific characteristics and that patient
treatment is different from that in the rest
of the world.
3
More often patients suffer
from diabetes mellitus, hypertension and
hypercholesterolaemia, less often they
have myocardial infaction and atrial fibril-
lation, are treated for primary prevention,
receive a dual-chamber device and the RV
defibrillation lead is more often placed in
the septal areas to mimic more physico-
logical ventricular activation.
1.
Ebrahim IO, Van der Walt A, Meyer R. A
prospective study based on a cohort from the
PANORAMA study evaluating CRT non-
responders, hyper-responders and super-
responders.
SA Heart
2011;
8
(4): 232–233.
2.
Okgreglicki A. Pacemaker implantation in
South Africa: Implant practices and differ-
ences in indications, modes and demograph-
ics from the Panorama Registry.
SA Heart
2011;
8
(4): 253.
3.
Al-Kandari F, Sweidan R, Al Fayyadh M.
Baseline characteristics and demographic
differences of patients implanted with an
implantable cardioverter defibrillator and
PANORAMA-Gulf observational study.
SA
Heart
2011;
8
(4): 227.
