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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 3, May/June 2020
AFRICA
163
management within the African context and novel/advanced
and potentially home-grown solutions. Presentations at the
conference were invited to focus on contemporary management
of arrhythmias with emphasis on setting up and sustaining
service provision in Africa. This report summarises the scope of
the first annual Cardiorhythm Africa meeting held in Nairobi
from 29–31 January 2020 and summarily presents the future
directions.
Purpose of the meeting
The main scope of the first Cardiorhythm Africa meeting was
to (1) raise the profile of cardiac arrhythmia in Africa and
form an executive committee to advise and promote healthcare
professional education as well as public awareness, (2) develop
within African healthcare specialists a network to advance
arrhythmia management along clinical, advocacy, research
and training lines, (3) initiate a pan-African conversation on
improving access to arrhythmia services involving clinicians,
funders, industry partners and patients, (4) form a network to
demonstrate expertise and referral opportunities within the
region and appraise the existing skill and mentorship models
that already exist within Africa, (5) provide a connection with
the diaspora and specialists from other networks, including
Europe and North America, and (6) engage with the specialists
in a detailed survey on arrhythmia care among different African
nations.
The scientific programme was organised in sessions, aligning
with clinical syndromes related to conduction and/or arrhythmia,
including (1) heart failure and device therapy, (2) heart block and
bradycardia, (3) syncope and sudden cardiac death, (4) drugs
and devices, (5) atrial fibrillation in Africa with a focus on rate
versus rhythm control and stroke prevention, (6) ventricular
arrhythmia, and (7) acute and long-term narrow-complex
tachycardia. A session with shared African cases and abstracts
allowed clinical discussions of common and unusual arrhythmia
presentations from around Africa and beyond. The programme
was completed with ‘The big ECG challenge’ a quiz organised by
the Egyptian Cardiac Rhythm Association.
The programme narrative was delivered through case
scenarios, live-in-box demonstrations and live cases, and allowed
showcasing of technology that many were not aware was available
in Africa. The scientific programme of the meeting sandwiched
three sessions focusing on the critical initiatives of the newly
birthed AFHRA. A detailed report of the AFHRA vision,
mission, strategies, current activities and future directions is
beyond the scope of this article and will be published separately.
Highlights from the scientific sessions
The scientific programme included 10 sessions with over 25
regional and international speakers covering a wide range of topics
in cardiac pacing and electrophysiology. Highlights included (1)
a live cardiac resynchronisation therapy (CRT-D) implant from
Nairobi, Kenya, with tips and tricks on implantation, patient
selection, responders and super-responders to optimal CRT; (2)
optimising drug therapy in heart failure, including the role and
place of novel agents such as sacubitril/valsartan and dapagliflozin,
and (3) an overview of conventional pacing indications followed by
a pre-recorded demonstration of His bundle pacing with clear
guidance on how to insert a His bundle lead.
Also discussed were sudden cardiac death in Africa, challenges
with making a diagnosis, challenges with risk stratification
and the current lack of data. There was a demonstration on
both transvenous and subcutaneous implantable cardioverter
defibrillator (ICD) implantation, as well as guidance on selection
of patients where this mode of treatment is indicated.
This was followed by an interactive live pre-recorded atrial
fibrillation (AF) ablation case, presentation of complications
of AF ablation and a heated discussion whether single-
shot technologies to ablate AF could be safely employed by
non-electrophysiologists. There was a presentation and discussion
on the eagerly awaited INVICTUS trial (a randomised trial of
rivaroxaban versus warfarin in patients with rheumatic AF),
which may have important implications in the management of
patients with rheumatic mitral valve disease in both AF and
sinus rhythm. Simplified coagulation pathways were presented to
assist clinicians in making decisions in the face of the expanding
number of locally available anticoagulants.
A masterclass was conducted on ventricular arrhythmia,
including case-based discussion around a patient with ischaemic
cardiomyopathy and ventricular tachycardia, focusing on
work-up and management options with drugs and catheter
ablation. The fellows-in-training were treated to a practical
workshop on pacemaker implantation and the basics of cardiac
electrophysiology.
The Fellows course wetlab
PASCAR president and CEO with newly appointed interim
AFHRA president