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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 2, March/April 2018
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AFRICA
cardiac arrhythmogenic disorders.
8-11
Therefore, health policies in
Africa should be aligned towards better management of cardiac
arrhythmias.
Unfortunately, the current situation in many African countries
is very worrisome. Our results show that there was a significant
heterogeneity in both access to care and use of CIEDs and EP
procedures across the African continent. In fact, the only SSA
country with the full armamentarium of arrhythmia services
was South Africa. This illustrates the magnitude of the challenge
facing many African countries as they set out to improve and
potentially expand cardiac arrhythmia care.
Given the high incidence of thromboembolic events among
patients with rheumatic heart disease, the use of anticoagulation
for Afib and INR monitoring need to be especially encouraged.
So is the use of proven and relatively simple therapeutic
options such as beta-blockers, amiodarone and class Ic anti-
arrhythmic drugs, as well as external electrical cardioversion for
haemodynamically compromised cardiac arrhythmias, which
require neither specific facilities nor technical expertise. This is
the starting point for the treatment of tachyarrhythmias in those
areas where resources are scarce. On the other hand, digoxin,
which is the first-line agent for rate control of Afib in most SSA
countries (Table 3), should be used cautiously, particularly in
the setting of SSA where facilities for monitoring serum digoxin
concentration are particularly lacking.
12-14
There is a clear need to promote contemporary cardiac
arrhythmia care in Africa and to address the disparity that
exists between different regions and countries. This will be a
huge and multi-faceted challenge. In Europe, the White Book
data have been used successfully to raise awareness about
inequalities in the treatment of arrhythmias, not only within the
cardiology community but also among healthcare administrators,
policymakers and other stakeholders.
15
Similar steps now also
need to be taken in Africa, using data from the first PASCAR
arrhythmia report and the results of this survey, and focusing first
on developing widespread basic arrhythmia services.
7
Table 4.Treatments available for atrial fibrillation and atrial flutter
Country
Aspirin
VKA
Apixaban
Rivaroxaban
Dabigatran
Electrical
cardioversion
Flutter ablation
AV node ablation
AF ablation (pulmo-
nary vein isolation)
Tunisia
x x
x x x x
South Africa
x x x x x x x x x
Sudan
x x x x x x
Kenya
x x
x x x x x
Gabon
x x
x x x
Sierra Leone
x x
x x x
Nigeria
x x
x x x
Mauritius
x x
x x
Algeria
x x
x
x x x x
Senegal
x x
x
x x x
Côte d’ivoire
x x
x
x
Tanzania
x x
x
x
Angola
x x
x
x
Zimbabwe
x x
x
Cameroon
x x
x
Uganda
x x
x
Niger
x x
x
Mozambique
x x
x
Burkina Faso
x x
x
Chad
x x
Guinea Conakry
x x
Congo Republic
x x
Mali
x x
Togo
x x
Burundi
x x
Mauritania
x x
Benin
x x
Central Africa Republic
x
Equatorial Guinea
x
Somalia
x
Malawi
x
Swaziland
x
Liberia
x
Ablation (simple and complex) remains largely unavailable in the region. VKA
= Vitamin K antagonist; AV = atrioventricular; AF = atrial fibrillation.
Table 5. Electrophysiological procedures
including complex catheter ablations
Country
PMK
CRT
ICD
Flutter ablation
AV nodal re-entry
ablation
Accessory pathway
ablation
AF ablation
Complex ablation
requiring 3D mapping
South Africa
x x x x x x x x
Algeria
x x x x x x x x
Kenya
x x x x x x x
Tunisia
x x x x x x
x
Senegal
x x x x x x
Sudan
x x x
Côte d’ivoire
x x x
Nigeria
x x x
Mauritius
x x x
Uganda
x x x
Cameroon
x
x
Benin
x
x
Tanzania
x
Mozambique
x
Sierra Leone
x
Angola
x
Burkina Faso
x
Zimbabwe
x
Mali
x
Togo
x
Mauritania
x
Gabon
x
Chad
Somalia
Malawi
Swaziland
Liberia
Burundi
Central Africa Republic
Equatorial Guinea
Guinea Conakry
Congo Republic
Niger
Ablation (simple and complex) remains largely unavailable in the region. PMK
= pacemaker; CRT = cardiac resynchronisation therapy; ICD = implantable
cardioverter defibrillator; AV = atrioventricular; AF = atrial fibrillation.