Permanent cardiac pacing: first Congolese experiment
Stéphane Méo Ikama, Jospin Makani, Xavier Jouven, Gisèle Kimbally-Kaky
The Pan African Medical Journal. 2015;20:381. doi:10.11604/pamj.2015.20.381.5803

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Letter to the editors

Permanent cardiac pacing: first Congolese experiment

Cite this: The Pan African Medical Journal. 2015;20:381. doi:10.11604/pamj.2015.20.381.5803

Received: 23/11/2014 - Accepted: 01/03/2015 - Published: 16/04/2015

Key words: Atrioventricular block, pacemaker, quality of life, Congo

© Stéphane Méo Ikama et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Available online at: http://www.panafrican-med-journal.com/content/article/20/381/full

Corresponding author: Stéphane Méo Ikama, Service de Cardiologie et Médecine Interne, CHU de Brazzaville, B.P. 2234 Brazzaville, Democratic Republic of Congo (stephane.mikama@gmail.com)


Permanent cardiac pacing: first Congolese experiment

 

Stéphane Méo Ikama1,&, Jospin Makani1, Xavier Jouven2, Gisèle Kimbally-Kaky1

 

1Service de Cardiologie et Médecine Interne, CHU de Brazzaville, B.P. 2234 Brazzaville, Democratic Republic of Congo, 2Service de Cardiologie, Hôpital Européen Georges Pompidou, Paris, France

 

 

&Corresponding author
Stéphane Méo Ikama, Service de Cardiologie et Médecine Interne, CHU de Brazzaville, B.P. 2234 Brazzaville, Democratic Republic of Congo

 

 

To the editors of the Pan African Medical Journal

In Africa, except the Maghreb countries and South Africa [1,2], the cardiac pacing activity is poorly developed for economic reasons and due to shortage of qualified personnel. Also, most establishments are done by means as of medical evacuations, or via the missions of cardiac pacing to humane aiming and formation [3]. This is the case of Congo, which benefitted from a French cardiac pacing mission in January 2012. In this preliminary study, we report about the Congolese experiment by presenting the profile of the first patients who underwent pacemaker implantation in Congo. The study was a longitudinal and descriptive one carried out in the service of cardiology and the surgical unit the University Hopsital of Brazzaville from January to September 2012. On an initial waiting list of 20 patients, eight died before the mission took place, and twelve answered the call favorably, but four did not come. The study related to eight patients who underwent pacemaker implantation during a French cardiac pacing mission. The effect of the pacemaker on the symptoms and the quality of life of the patients were evaluated according to the CDC-HRQOL4. Mean age of patients was 70.4 ± 6 years. There were four men and four women. Five patients were living in Brazzaville and three came from others departments. Functional signs consisted of: dyspnea (7 cases), syncope (3 cases), syncopal equivalents (2 cases). One patient was asymptomatic. The average heart rate was 37.4 beats per minute (range: 27 and 49 beats). ECG showed: a complete atrioventricular block (6 cases), an atrioventricular block of second degree (2 cases). Cephalic venous access was used in six patients and subclavian in two others. A cardiac arrest occurred in three patients, cardiac massage was performed, in the absence of temporary stimulation and isoprenaline. All patients notified improvement of symptoms and quality of life during the first month of implantation. No complication was observed during the nine months of follow-up. The management of cardiac rhythm and conduction disorders remains difficult in Sub-Saharan Africa. Indeed, if the fundamental problems are that of the insufficiency of the technical support center, the often modest social conditions of the populations constitute also a constraint to accessibility to care. As regards cardiac stimulation, the complete atrioventricular block or of high degree constitutes of it the principal indication [4,5]. The pacemaker implantation, in rather simple rule, can sometimes be peppered with incidents during intervention, in particular in our context. A cardiac arrest can occur, favoured at the same time by the importance of the bradycardia, the absence of temporary stimulation and positive chronotropic drugs (Isoprenaline). It is in addition necessary to underline the long period of waiting between the moment when the indication of installation of pacemaker is retained and its effective realization. In Africa, much longer evolutions are often observed among patients carrying complete atrioventricular block. The risk of sudden death being always possible, this one could enamel the spontaneous evolution of some of our defaulted patients. The beneficial effect of the pacemaker on the improvement of the symptoms and the quality of life of the patients, raised in our study, was reported by other authors [6].

 

 

Conclusion

The pacemaker implantation is now a reality in Congo. This preliminary study showed the benefit of the pacemaker implantation on the symptoms and the quality of life of the patients. Also, this activity should be continued in order to decrease the health expenditure subsequent to medical evacuations costs.

 

 

Competing interests

The authors declare no competing interest.

 

 

Authors’ contributions

All authors read and approuved the final manuscript.

 

 

Acknowledgements

We thank Professor Xavier JOUVEN to have made possible the cardiac pacing activity in Congo.

 

 

References

  1. Bouhouch R, Abdelali S et Fellat N. Les stimulateurs cardiaques: à propos de 228 patients. Maghreb Médical. 1997; 316 : 42-46. Google Scholar

  2. Millard RN. Cardiac Arrythmia Society of South Africa, 1998 Survey of cardiac pacing in South Africa-Report of the working group on registries of the cardiac arrythmia society of South Africa (CASSA). S Afr Med J. 2001; 91 : 873-876. Google Scholar

  3. Thiam M, Fall PD, Gning SB et al. La stimulation cardiaque définitive en Afrique de l'Ouest: faisabilité, problèmes et perspectives. Ann Cardiol Angéiol. 2003; 52: 212-214. Google Scholar

  4. Diao M, Diop IB, Leye MMCBO et al. La stimulation cardiaque définitive à propos de 62 cas : indications, techniques et surveillance. Cardiol Trop. 2005; 31(123): 31-34. Google Scholar

  5. Yayehd K, Ganou K, Tchamdja T, Tété Y, N'cho Mottoh MP, Pessinaba S, Damorou F. [Management of high-grade atrioventricular block in Lomé, Togo]. Med Trop (Mars); 2011 Dec;71(6):637-8. Google Scholar

  6. Ekpe EE, Aghaii MA, Edaigbini SA, Onwutu CN. Cardiac pacemaker treatment of heart block in Enugu: a 5 year review. Niger J Med. 2008; 17(1): 7-12. PubMed | Google Scholar

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


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