54 / 84
CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 2, March/April 2018
116
AFRICA
affordable in many African countries. In addition, there are
disparities in cardiovascular healthcare between countries,
which are not properly documented. These disparities need
to be established for developing south–south collaboration
between more developed countries and those with a lack of
facilities.
The first studies of pacemaker and implantable cardioverter
defibrillator implantation rates in SSA were conducted about
20 years ago.
3-5
These studies, together with a recent evaluation
of access and use of cardiac implantable electronic devices
(CIED) and catheter ablation procedures show very low levels
of use and access to CIEDs in SSA. The Pan-African Society
of Cardiology (PASCAR) Sudden Cardiac Death Task Force
has conducted the first pan-African survey on human resources,
diagnostic tools and treatment for cardiac arrhythmias across
African countries.
Methods
We conducted a survey across African countries using an
electronic questionnaire (Table 1) between 15 October and 15
December 2017. This was completed by general cardiologists
and electrophysiologists from the PASCAR community. The
questionnaire focused on availability of human ressources,
diagnostic work up and treatment in each country. Blinded
multiple responders per country were requested as much as
possible. In case of significant disparities in the information from
multiple responders, they were invited to revise their responses.
For countries in SSA that do not have cardiac physicians,
information was obtained from official authorities such as the
embassy of the country in question.
Results
Of the 55 African countries, data from 33 countries were
available. In 19 (63%) of the countries, data were provided from
at least two responders.
Human resources
To the best of our knowledge, six (18%) countries did not have
a registered cardiologist in 2017. These were Central African
Republic, Equatorial Guinea, Liberia, Malawi, Somalia and
Swaziland. In addition, 11 (33.3%) countries had no trained
physicians capable of performing pacemaker implantations (Fig.
1). Fellowship training courses in cardiac pacing for physicians
and technologists to provide the required expertise were available
in all North African countries, in contrast to SSA countries
where this exists in South Africa only.
As shown in Fig. 2, most operators obtained their baseline
skills in Europe, followed by their own country or another
African country, and the minority in Asia or North America.
More importantly, almost 60% of these experts did not receive
any postgraduate training overseas, and only one-third benefited
from a fellowship programme in Europe (Fig. 3). The University
of Cape Town has trained three fellows in cardiac pacing from
Tanzania, Sierra Leone and Kenya as part of the PASCAR
fellowship in cardiac pacing, and a similar training programme
has been launched at the University of Gaston Berger, Saint
Louis, Senegal.
Table 1. Questionnaire administered for the survey of
arrhythmia services in Africa
1. In which country are you currently practicing medicine?
2. In which centre are you performing electrophysiology and/or pacing?
Select all applicable options.
a. Public non-teaching hospital
b. Teaching hospital
c. Private sector
3. In how many centres in your country are patients able to receive
a. Pacemaker implantation
b. CRT (cardiac resynchronisation therapy)
c. ICD (implantable cardioverter–defibrillator)
d. Catheter ablation procedures?
4. What is the percentage of public hospitals in your country that supply elec-
trophysiology and/or pacing?
5. Where did you receive your training in electrophysiological procedures and/
or pacing?
a. Current country
b. Another African country
(please specify)
c. Asia
d. Europe
e. America
6. Have you travelled abroad for a short-term fellowship in electrophysiological
procedures and/or pacing? If yes, where?
a. No
b. Another African country
(please specify)
c. Asia
d. Europe
e. America
f. Australasia
7. Which of the following procedures you are able to perform?
Select all applicable options.
a. Pacemaker
b. CRT (cardiac resynchronisation therapy)
c. ICD (implantable cardioverter–defibrillator)
d. Catheter ablations
e. None
8. How many physicians in your country are able to
a. Implant pacemakers
b. Implant ICD
c. Implant CRT
d. Perform ablation procedures?
9. Which of the following diagnostic drugs are available in your country?
Please select all applicable options
a. Ajmaline iv
b. Flecanide iv
c. Other, please specify
10. Which of the following anti-arrhythmia drugs are available in your country?
Please select all applicable options
a. Amiodarone iv
b. Xylocaine iv
c. Beta-blockers iv
d. Digoxine iv
e. Procainamide
f. Flecainide
g. Hydroquinidine
11. Which of the following are used in the treatment of atrial fibrillation/flutter
in your country? Please select all applicable options
a. Aspirin
b. Clopdiogrel
c. VKA (Vitamin K antagonist)
d. Apixaban
e. Rivaroxaban
f. Dabigatran
g. Electrical cardioversion
h. Flutter ablation
i. AV node ablation
j. AF ablation (pulmonary vein
isolation)
12. Which of the following diagnostic tools are used in your country?
Please select all applicable options
a. 12-lead ECG
b. Signal-averaged ECG
c. Holter ECG
d. 2D echo
e. Tilt-table testing
f. Exercise testing
g. Nuclear imaging
h. Coronary angiography
i. Right ventricle angiography
j. Cardiac CT scan
k. Cardiac MRI
13. Which of the following invasive therapies are used in your country?
Please select all applicable options
a. Pacemaker implantation
b. CRT implantation
c. ICD implantation
d. Flutter ablation
e. AV nodal re-entry ablation
f. Accessory pathway ablation
g. AF ablation (pulmonary vein isolation)
h. Complex ablation requiring 3D mapping (ventricular tachycardia, PVCs,
atrial tachycardia)
14. Please provide contact details (voluntary) to allow us to keep you abreast of
developments
a. Title, name and surname
b. Institution name
c. E-mail address
d. Mobile number