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 AFRICA 13
most frequent complication was lead failure in nine patients
(17.6%). The risk of IS and device complications at three years
was 13.7 and 21.6%, respectively, and eventually remained
constant over the time.
Conclusion: This study demonstrated that ICD implantation
has a high risk of complications, mainly during the early period
after device implantation. A higher rate of IS as well as a very
low risk of arrhythmic events in asymptomatic BrS patients
advocates us to carefully evaluate this young and otherwise
‘healthy’ population in the decision-making.
INCIDENCE OF SUDDEN CARDIAC DEATH IN SUB-
SAHARAN AFRICA: THE DOUALA SCD REGISTRY
Bonny Aimé*, Ngantcha Marcus1, Jonas WA2, Fonga Rene3,
Saka Cecile4, Ndongo Amougou Sylvie5
*Douala Cardiovascular Research Centre, University of
Douala, Cameroon;
1Statprest, Paris, France
2Hopital de district Bonassama
3Hopital de district de New-Bell
4Hopital Laquintinie de Douala, Cameroun
5Centre Hospitalier, Universitaire de Yaoundé, Cameroun
Background: A population-based incidence estimate of sudden
cardiac death (SCD) in sub-Saharan Africa (SSA) is unknown.
We sought to determine the epidemiology of SCD in Douala,
Cameroon.
Methods and Results: During 12 months, four districts were
randomly chosen in which to monitor all deaths. The COSA
(‘comité de santé’) of each area registered every death, and a
postgraduate fellow recorded detailed demographic and medical
data for victims of natural death. A senior physician studied every
case of suspected sudden death, either cardiac or extra-cardiac.
For optimal thoroughness, surrounding mortuaries were checked
simultaneously to match identities of victims. Established SCD
was defined as a rapid, witnessed collapse leading to death within
one hour of onset of symptoms, and probable SCD was defined
as unexpected death within 24 hours without obvious extra-
cardiac cause. Our registry numbered 240 000 people with 2 304
deaths. The overall mortality rate was 9.6/1 000 inhabitants/year.
Four (0.3%) were sudden extra-cardiac deaths, and 58 (2.5%) were
SCDs, of which 41.4% were established and 48.3% were in under
40-year-olds. The incidence rate of SCD was 11.7/100 000 person-
years. Coronary artery disease or dilated cardiomyopathy was
diagnosed in 13.8% cases. Out-of-hospital cardiac arrest (OHCA)
occurred in 58.6% of the victims, of which 35.3% occurred at
home, and 58.8% in a taxicab to hospital. Witnessed cardiac
arrest was reported in 86.2% of cases, but only 7.4% of victims
experienced cardiopulmonary resuscitation attempts.
Conclusion: The SCD incidence in this city of a SSA coun-
try was similar to some reports from Western populations.
However, the absence of CPR attempts raises the question of
developing basic life support programmes in SSA to tackle this
potentially reversible lethal cardiovascular condition.
BLACKOUTS AND SUDDEN DEATH IN THE APPAR-
ENTLY WELL AND YOUNG. THE CASE OF LONG QT
SYNDROME: MISSED OPPORTUNITIES FOR DIAGNO-
SIS AND TREATMENT
Brink Paul*, Goosen Althea, Heradien Marshall1
Division of Medicine, University of Stellenbosch and Tygerberg
Hospital, Cape Town, South Africa;
1Cardiologist, Cape Town, South Africa
Background: The long QT syndrome (LQTS) is a pro-arrhyth-
mic cardiac disorder associated with blackouts (transient loss
of consciousness; TLOC). It is necessary to recognise that these
events are syncope and not epilepsy or another type of attack.
Sometimes the syncope-causing ventricular tachycardia may
degenerate into ventricular fibrillation and death. LQTS is auto-
somal dominantly inherited and causal mutations (1 000+) have
been identified in 13 genes.
Methods: Through cascade screening of relatives of 26 LQTS
index cases, we identified 203 living persons with the same
potassium channel mutation, namely KCNQ1 A341V. Clinical
histories have been collected on all of them. We also collected
information on deaths of close relatives. Many symptomatic
individuals with a history of blackouts were not diagnosed with
LQTS. We set out to quantitate these missed diagnoses.
Results: Of the mutation carriers, 160 (79%) experienced black-
outs. Only 26% were diagnosed as LQTS and appropriately
treated. Epilepsy was the diagnosis in 40%. Another 34% had
layman’s explanations, or a medical diagnosis such as ‘vasova-
gal’ or ‘sick sinus syndrome’. A number of ‘near-drowning’
events were documented. Historic sudden deaths before age 20
years were 23. Half of these were drownings, all in able swim-
mers. Other examples are a girl, aged 13 years, dying on a skat-
ing rink while under treatment for epilepsy, and a boy, aged five,
who ‘choked on water’.
Conclusion: Our experience shows gross disparities in diagnosis
and the consequent management in a treatable risk for sudden
death. Missed opportunities for diagnoses ranged from prior
events to medical encounters, and at and after the first presenta-
tion. The most common misdiagnosis was epilepsy in the living,
and drowning in the dead. Missed diagnosis and misdiagnosis
may be prevented by changing how both lay persons and medi-
cal professionals perceive TLOC and also near drowning and
drowning events. As said by a teacher of mine: ‘You only recog-
nise what you know’.
IDENTIFICATION OF TWO TNNI3 GENE MUTATIONS,
ONE NOVEL AND ONE ARISING DE NOVO, IN SOUTH
AFRICAN PATIENTS WITH RESTRICTIVE CARDIOMY-
OPATHY AND FOCAL VENTRICULAR HYPERTROPHY
Brink Paul*1, Mouton Jomien2, Pellizzon Adriano1, Goosen
Althea,1 Kinnear Craig 2, Herbst Phillip1, Moolman-Smook
Hanlie2
*1Division of General Internal Medicine, Department of
Medicine, University of Stellenbosch and Tygerberg Hospital,
Stellenbosch, South Africa;