Managing Arrhythmias in AFRICA

26 Pages·2015·1.62 MB·English

by  Ashley Chin

Pacemaker and ICD Re-use in AFRICA
– the Cape Town experience
Ashley Chin
MBChB, FCP(SA), MPhil, FHRS
Cardiologist/Electrophysiologist
Groote Schuur Hospital
University of Cape Town
South Africa

PASCAR 2015, Mauritius
Outline
Current Status of Pacing and ICD use in AFRICA
– 2014 PASCAR Survey of Pacing and ICD use in
Africa

Pacemaker and ICD re-use in Groote Schuur
Hospital, Cape Town, South Africa

PASCAR fellowship in cardiac pacing
“Permanent pacing remains one of the
... Still unavailable to many patients living
most cost effective treatments
in Africa today...
available in modern medicine”
5800 5858 Activitrax® MicroMinix® Thera ® EnPulse®
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1958 1970 1986 1990 1995 2004 2015 est

1960
1979 1989 1991 1998 2006

First Implantable Pacemaker Du al chamber Rate re sponse via activity M VP, Full
rate response & minute ventilation automaticity
Chardack-Greatbatch Byrel® Synergist™ Elite™ Kappa® Adapta™

R Sutton, The foundation of Cardiac Pacing 1991
PM implantation rate
in EUROPE
Brignole et al , 2013 ESC pacing guidelines
PACING in AFRICA
11th World Survey of Cardiac Pacing and ICDs in 2009 included 2 African countries
POPULATION PM CENTRES PM IMPLANTS PM
(million) 2009 2009 (Units per
million)
SOUTH AFRICA 49 47 2939 60
SUDAN 39 4 180 5
SPAIN 45 116 25595 569
PM implantation rates are very low in 2 African countries compared to other
European countries with a similar population
Mond et al , PACE, August 2011
2014 PASCAR SURVEY on PACING
and ELECTROPHYSIOLOGY in AFRICA
ACKNOWLEDGEMENTS:
Bongani Mayosi (PASCAR President)
Aime Bonny (Chair – PASCAR Task Force on Sudden Cardiac Death)

PARTICIPANTS:
Ashley Chin (South Africa), Isaac Kofi Owusu (Ghana), Adama Kane (Senegal), Houenassi
(Benin), Jeilan (Kenya), A Gehani (Libya), Diakite Mamadou (Mali), Toure Ali Ibrahim (Niger),
Sonia Marrakchi (Tunisia), Kamilu Karaye (Nigeria), Maiduguri (Nigeria), Anastaze Dzudie
(Cameroon), Tantchou Cabral (Cameroon), Ouankou Debozard (Cameroon), James Russel
(Sierra Leone), Icham Bouzelmat (Morocco), Brahim Hamdaoui (Morocco), Awad
Mohamed (Sudan)

14 African countries
PACING in AFRICA in 2014
COUNTRY PM PM PM/CENTRE PM (2013) Re-used PM
CENTRES DOCTORS (2013)
Severe shortage
SOUTH AFRICA 54 173 144 3859 Yes
of PM centres
TUNISIA 60 200 2000 No
exist in all
MOROCCO 7 600-700
countries
SUDAN 517
surveyed
KENYA 6 20-30

NIGERIA 5 3
Severe shortage
SENEGAL 3 11 89 89 Yes (22%)
of PM doctors
CAMEROON 3 3 26 80 No
Mostly low-
LIBYA 2 4 50
volume
GHANA 2 2 16
implanters
BENIN 1 1 19

MALI 1 2 16
PM implantation
NIGER 0 0 0
rate is very low
SIERRA LEONE 0 0 0
UGANDA Yes
2014 PASCAR SURVEY on PACING and EP in AFRICA
PACING in SOUTH AFRICA
PM (Units per million)
80
60
Increase in PM implants over
40
time but rates are still low
compared to Europe
20
0
1995 1998 2001 2009 2014
Increase in PM doctors:
112 PM doctors (31 centres) in 1998
173 PM doctors (54 centres) in 2014

Scott Millar, S Afr Med J 2001
PACING in SOUTH AFRICA
Large geographic and racial discrepancies

Few PM doctors in 4 provinces in SA in 2014 (14 406 500 people)

3700 patients/year may have AV block without a PM (1998)
Scott Millar, S Afr Med J 2001
ICDs in AFRICA
2009
11th World Survey of Cardiac Pacing and ICDs in included 2 African countries
POPULATION ICD IMPLANTS ICD
(million) (2009) (Units per
million)
SOUTH AFRICA 49 308 6
SUDAN 39 2 <1
SPAIN 45 2930 65
Mond et al , PACE, August 2011