CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 4, July/August 2014
AFRICA
177
tion attempts during the time frame of sudden cardiac arrest
(SCA) in various patient populations throughout African
countries.
Conclusion:
This study will provide comprehensive, contem-
porary data on the epidemiology of SCD in Africa and will
help in the development of strategies to prevent and manage
cardiac arrest in this region of the world.
Keywords:
sudden cardiac death, epidemiology, ethnicity, Africa
Submitted 25/3/14, accepted 13/6/14
Cardiovasc J Afr
2014;
25
: 176–184
DOI: 10.5830/CVJA-2014-035
For many years there has been a debate about the definition
and nature of ‘sudden death’ or out-of-hospital cardiac arrest.
1-8
Issues pertaining to this debate have been the temporal definition
of ‘sudden’, whether death was unexpected, whether death was
witnessed, and the aetiology of the event. The time frame used
to describe the duration of the terminal event initially was 24
hours. The current definition of sudden cardiac death (SCD)
describes death within one hour of the onset of symptoms,
2
since this period seems to describe most accurately patients with
arrhythmic sudden cardiac death.
9
A very difficult issue is the classification of unwitnessed deaths.
Most authors have erred in favour of classifying such events as
SCDs, even though it is often impossible to determine when the
patient was last seen alive or the duration of symptoms prior
to death. Hence, SCD can be defined as follows: ‘Natural death
due to cardiac causes, heralded by abrupt loss of consciousness
within one hour of the onset of acute symptoms’. Pre-existing
heart disease may have been known to be present, but the time
and mode of death are unexpected.
1
The incidence of SCD occurring out of hospital varies
with age, gender and presence or absence of cardiovascular
disease. Incidence rates of SCD between 0.36 and 1.28 per
1 000 inhabitants per year have been reported in Europe and the
United states.
10-13
In these studies, only witnessed victims seen
or resuscitated by the emergency medical services are included;
these data therefore underestimate the incidence of SCD in the
general population. Sudden cardiac death is responsible for
about 300 000 to 400 000 deaths per year in Europe and the
United States, respectively.
14
Several diseases linked with sudden cardiac arrest (SCA) have
been reported.
15,16
Autopsy studies in unselected subjects suggest
that about two-thirds of such deaths are cardiac in origin, with
coronary artery disease and its complications accounting for the
overwhelming majority of deaths in the industrialised world.
17,18
Indeed, coronary artery disease (CAD) is the leading cause of
sudden death worldwide.
3
Table 1. Reported cases of syncope or sudden cardiac death in black Africans living in Africa
Main disease
Authors
Title
Country
Type of
publication Journal and year
Size
(patients)
1 BrS
Bonny A,
et al.
Brugada syndrome in pure black
Africans
Ivory Coast,
Benin, RD
of Congo
Article
Journal of Cardiovascular
Electrophysiology
2008
6
Ouali S,
et al.
Clinical and electrophysiological profile
of Brugada syndrome in the Tunisian
population
Tunisia Article
Pacing and Clinical
Electrophysiology
2011
24
2 HCM
Hiam I,
et al.
Mort subite du sportif au Sénégal: étude
rétrospective sur 8 ans
Senegal
Abstract
PASCAR conference,
Dakar 15–20 May, 2013
5
3 IHD
Rotimi O,
et al.
Sudden unexpected death from cardiac
causes in Nigerians: a review of 50
autopsied cases
Nigeria Article
International Journal of
Cardiology
1998
50
4 Paediatric sample Arthur JT,
et al.
Sudden deaths: cardiac and non-cardiac
in children in Accra
Ghana Article
West Africa J
1995
16
5 CAD and RHD Schneider
J,
et al.
Causes of sudden death in Addis Ababa,
Ethiopia
Ethiopia Article
Ethiop Med J
2001
63
7 Unknown
Houenassi
M,
et al.
Aspect epidémiologiques de la mort
subite dans la ville de Parakou
Benin
Abstract
PASCAR conference,
Dakar 15–20 May, 2013
23
8 Multiple causes
(CAD, DCM,
LQTS, RHD)
Talle MA,
et al.
SCD in sub-Saharan Africa: A 12-month
review in University of Maiduguri
Teaching Hospital, Nigeria
Nigeria Abstract
PASCAR conference,
Dakar 15–20 May, 2013
17
9 Multiple causes
(DCM, CAD, RHD)
Thiam I,
et al.
La mort subite cardio-vasculaire au
Sénégal- Etude rétrospective sur 7 ans
Senegal
Abstract
PASCAR conference,
Dakar 15–20 May, 2013
235
10 LQTS
Leye M,
et al.
QT long congenital syncopal évocateur
de Syndrome de Jervell Lange Nielsen
Senegal
Abstract
PASCAR conference,
Dakar 15–20 May, 2013
1
11 NCCM
Kamotho
C,
et al.
A rare presentation of non-compaction
cardiomyopathy in Kenya
Kenya
Abstract
PASCAR conference,
Dakar 15–20 May, 2013
1
12 ARVD/C
Kouakam
C
Syncope in a black African with arrhyth-
mogenic right ventricular dysplasia
Cameroon Unpublished
data
Unpublished data
1
13 Hypertensive CMP
(mainly)
Akinwusi
PO,
et al.
Pattern of sudden death at Ladoke Akin-
tola University of Technology Teaching
Hospital, Osogbo, south-west Nigeria
Nigeria Article
Vascular Health Risk
Management
2013
Approx
16
BrS: Brugada syndrome, HCM: hypertrophic cardiomyopathy, CAD: coronary artery disease, PASCAR: Pan-African Society of Cardiology,
LQTS: long QT syndrome, RHD: rheumatic heart disease, DCM: dilated cardiomyopathy, ARVD/C: arrhythmogenic right ventricular dysplasia/
cardiomyopathy, CMP: cardiomyopathy.
