CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 10, November 2012
538
AFRICA
Follow up in a developing country of patients with
complete atrio-ventricular block
JC TANTCHOU TCHOUMI, SARA FORESTI, PIERPAOLO LUPO, RICCARDO CAPPATO, GIANFRANCO BUTERA
Abstract
Aim:
The purpose of the study was to assess the incidence
and survival rate of patients with complete atrio-ventricular
block in the cardiac centre of St Elizabeth Catholic General
Hospital, Kumbo, Cameroon.
Methods:
Between 2009 and 2011, 26 patients with complete
atrio-ventricular block were diagnosed at our institution.
Complete atrio-ventricular block was defined as complete
heart block, diagnosed by echocardiographic or electro-
cardiographic documentation of the dissociation between
electrical activity of the atria and ventricles. Hospital charts,
electrocardiograms (ECG), echocardiography and chest
radiography were reviewed.
Results:
The triad of symptoms that pointed to the diagno-
sis of complete atrio-ventricular block was mainly fatigue,
shortness of breath on mild physical exertion, and dizziness.
The median age at diagnosis was 65
±
15
years. The escape
rhythm showed a narrow QRS complex in 35.2% of patients,
whereas wide QRS complexes were seen in 64.8%. In only
15
patients were pacemakers implanted: dual-chamber in 10
and single-chamber in five cases, depending on the availabil-
ity of the pacemakers. During the observational period, five
non-implanted patients died, giving a mortality rate of 45%.
We recorded no deaths in patients with pacemakers.
Conclusion:
In developing countries, natural selection is
observed in patients with complete atrio-ventricular block.
Lack of infrastructure and early detection, and financial
limitations are the main problems faced in the follow up of
these patients. Re-organisation of the public health system,
new programmes for the prevention of cardiovascular diseas-
es, and government subsidisation are needed in our milieu.
Keywords:
complete atrio-ventricular block, follow up, cardiac
centre
Submitted 24/8/11, accepted 30/8/12
Cardiovasc J Afr
2012;
23
: 538–540
DOI: 10.5830/CVJA-2012-059
Over the past years, cardiac pacing has become the standard
mode of therapy for heart block and its complications. The
increasing use of cardiac pacemakers (PM) has been encouraged
by improved and simplified techniques of permanent pacing,
by the development of more dependable electrodes and pulse
generators, and by increasing clinical experience and follow-
up data, indicating a favourable effect on the prognosis and
improved cardiovascular performance.
1
Across Europe in 2005, the number of new implants of
pacemakers ranged from 121 to 1 134 per million, and for
implantable cardiac defibrillators from 1.18 to 226 per million.
2
In countries of sub-Saharan Africa, patients with complete atrio-
ventricular block (CAVB) and other indications for pacing are
sent home because of non-availability of facilities for pacemaker
implantations, limited availability of pacemakers, and high cost
of the implantation procedure. The aim of the study was to
assess the incidence and survival in patients with CAVB during a
period of 16 months at the cardiac centre of St Elizabeth Catholic
General Hospital, Shisong, Cameroon.
Methods
CAVB was defined as a complete heart block, diagnosed by
echocardiographic or electrocardiographic documentation of the
dissociation between electrical activity of the atria and ventricles.
Hospital charts, electrocardiogram (ECG), echocardiography
and chest radiography were reviewed. We analysed X-rays for
cardiomegaly, which was defined as cardiothoracic ratio
>
0.5.
Between 2009 and 2011, 26 patients with complete atrio-
ventricular block were diagnosed at our institution. Structural
heart diseases were diagnosed as follows: eight patients had
hypertensive cardiomyopathy, seven had mild mitral valve
regurgitation with degenerative aetiology, five had moderate
mitral valve regurgitation with post-rheumatic aetiology
associated with moderate tricupid valve regurgitation, one case
had post-surgical complete atrio-ventricular block, one case
had severe pulmonary artery valve stenosis, and the rest of the
patients had no cardiac pathology.
Local anaesthesia was given in the left subclavicular area
using 20 ml of lidocaine. The left subclavian vein was punctured
and the guidewire was inserted for monocameral pacemakers.
Two punctures were performed when we intended to implant
a bicameral pacemaker. A pocket was created at the left
subclavian area. Through the 9 and 7 french introducers we sent,
respectively, the right atrial and the right ventricular leads in the
case of a bicameral pacemaker. Through the 7 french introducer
we sent the ventricular lead for a monocameral pacemaker. These
introducers were observed by means of radiography.
The intra-operative parameters are reported in Table 1. These
parameters were optimised three months after the implantation.
The leads were anchored with silk 2.0 and the pacemaker
was connected. Two layers of stitches were put in: the first,
subcutaneous with vicryl 2.0 and the second, intradermic with
Cardiac Centre, St Elizabeth Catholic General Hospital,
Kumbo, Cameroon
JC TANTCHOU TCHOUMI, MD, PhD,
Department of Electrophysiology, Policlinico San Donato
IRCCS, Milan, Italy
SARA FORESTI
PIERPAOLO LUPO
RICCARDO CAPPATO
Department of Pediatric Cardiology and Cardiac Surgery,
Policlinico San Donato IRCCS, Milan, Italy
GIANFRANCO BUTERA, MD, PhD
