Cardiovascular Journal of Africa: Vol 26 No 5 (September/October 2015)

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CARDIOVASCULAR JOURNAL OF AFRICA • Vol 26, No 5, October/November 2015 12 AFRICA
old, and 6% from those 65 years or older. The mean age was 29
years (range 0–102 years). Over the 11-year period, the annual
mean incidence rate (IR) for GAS isolates was 1.38 cases per
100 000 person-years (py). Seven hundred and five cases of these
isolates (9.46%) met the case definition of invasive GAS, with
a mean annual IR of 0.13 cases per 100 000 py. Over the study
period, both invasive and non-invasive GAS isolation showed a
bimodal-shaped curve.
Conclusion: Laboratory data showed a fall in the incidence rate
of GAS isolation from South African patients over the last 11
years. Within the invasive GAS isolates, IRs showed significant
fluctuations over the study period.
STATISTICS ON THE USE OF CARDIAC ELECTRONIC
DEVICES AND ELECTROPHYSIOLOGICAL PROCE-
DURES FROM 2011 TO 2014 IN 27 AFRICAN COUNTRIES:
FIRST REPORT FROM THE PAN-AFRICAN SOCIETY
OF CARDIOLOGY (PASCAR) ARRHYTHMIA STUDY
GROUP
Bonny Aimé*, Talle Mphammed A1, Karaye Kamilu M 2,
Dzudie Anastase3, Kane Adama4, Salah Mohamed5, Kaviraj
Bundhoo6 , Kumar Karooa Aswinee7, Chin Ashley8, Belayneh
Dereje Ketema9
*Douala Cardiovascular Research, University of Douala,
Douala, Cameroon;
1University Hospital of Maiduguri, Nigeria
2University Hospital of Kano, Nigeria
3General Hospital of Douala, Cameroon
4CHU Le Dantec, Dakar, Senegal
5University Hospital, Khartoum, Sudan
6Hospital of Rose Hill, Mauritius
7Hospital of Quatre-Bornes, Mauritius
8University Hospital of Cape Town, South Africa
9University Hospital of Addis Ababa, Ethiopia
Background: Lack of data on cardiac electronic devices and
electrophysiological (EP) procedures in Africa is impeding the
formulation of appropriate health policies on managing cardiac
arrhythmias. We conducted a survey on pacing and EP activities
throughout Africa.
Methods: A questionnaire regarding activities from 2011 to 2014
was sent to EP physicians. Additional information was obtained
through manufacturers or local distributors.
Results: Twenty-seven countries were surveyed, out of which
six (22%) did not report their data and five (19%) did not have
any cardiac EP services. Twenty-four centres were included, of
which 20 (83%) were from the public sector. No country had a
centralised national registry. Among the 16 countries (76%) with
facilities for implanting cardiac devices, cardiac resynchronisa-
tion therapy (CRT) was performed in nine (56%), implantable
cardioverter-defibrillator (ICD) in 11 (68.7%), and EP proce-
dures in six (37.5%) countries. Only four (25%) countries offered
the full complement of EP services (pacemaker, CRT, ICD and
simple/complex ablations), with none from West, Central and
East Africa. Per million inhabitants, median number of centres
was three (1–60) and implanting physicians was nine (2–173).
The implant rates per million habitants were 36.7 (0.2–218).
Re-used devices were implanted in six (37.5%) countries,
accounting for up to 11% of all procedures, with a median rate
of 4%. The patient charges for dual-chamber (DDD) pacemaker
implantation ranged from $0.00 (in countries with reimburse-
ment policies) to $5 556 (in private clinics), with a median cost
of $2 570. Wide variations in cost were observed across the
countries, with a high inter-centre variability. An inverse corre-
lation between implant rates per million inhabitants and proce-
dure fees standardised to gross domestic product per inhabitant
(correlation coefficient r² = –0.17) was found.
Conclusion: Although increasing in most countries, pacemaker
implantations are still sub-optimal in sub-Saharan Africa, and
EP procedures are in their embryonic stages. The high cost of
procedures in this setting of pay-out-of-pocket policies, under-
use of recycled devices, lack of national registries, and the
deficit of trained specialists limit expanding the management
of arrhythmia diseases in Africa. South–south and north–south
cooperation is needed.
INCIDENCE OF INAPPROPRIATE ICD SHOCKS AND
OTHER COMPLICATIONS IN ASYMPTOMATIC
VERSUS SYMPTOMATIC BRUGADA SYNDROME
Bonny Aimé*, Ngantcha Marcus1, Bouzeman Abdeslam2
*Douala Cardiovascular Research Centre, University of Douala,
Cameroon; and Pitié-Salpêtrière Hospital, Paris, France; aime-
1Statprest, Paris, France
2CMC Parly 2, Le Chesnay, France
Background: Brugada syndrome (BrS) requires implantation
of a cardioverter–defibrillator (ICD) to prevent sudden cardiac
death. However, the ICD indications in asymptomatic patients
remain conflicting.
Methods and Results: We compared the rate of ICD complica-
tions in asymptomatic versus symptomatic BrS patients. ICD
interrogations were done every three to six months. Given the
low prevalence of BrS in the general population, 10% of the
risk α for the bilateral statistical test significance was chosen.
We studied 51 patients, 86.5% male, mean age 47 ± 11 years at
diagnosis. At diagnosis, 18 patients (35%) were asymptomatic,
25 patients (49%) experienced syncope, and eight (16%) had
been resuscitated from ventricular fibrillation. During a mean
follow up of 78 ± 46 months, none of asymptomatic patients
experienced appropriate therapy, whereas 21.6% of sympto-
matic patients had one or more shocks. Overall complication
rate was 27.4%. Inappropriate shocks (IS) occurred in seven
patients (13.7%; mean 6.57 ± 6.94 shocks per patient), 16.14 ±
10.38 months after ICD implantation, and lead fracture was the
primary cause (n = 4, 57.1%). The incidence of IS was higher
in asymptomatic patients (p = 0.09). Device-related complica-
tions were similar in both groups (p = 1). A total of 14 patients
(27.4%) had one or more complications. The mean interval from
implantation to a complication was 13.91 ± 12.98 months. The