Cardiac Pacing: Indications, Modalities, Complications, and Challenges (results of a Multicenter Cross-sectional Study in Four Hospitals in Dakar, Senegal)

Introduction: cardiac pacing is the only lifesaving procedure which is effective for major cardiac conduction disorders. In sub-Saharan Africa, few pacemakers are implanted, compared to Western countries. This study aimed to describe the indications for cardiac pacing in four hospitals in Senegal, to evaluate its practical modalities, to identify pacemaker's complications and their predisposing factors and to evaluate the main challenges for cardiac pacing in Senegal.

Methods: we carried out a retrospective study over four years and eight months, from January 2015 to July 2019 in four hospitals in Dakar (Senegal). All patients who received a single-chamber or double-chamber permanent pacemaker were included. Variables included age, gender, symptoms, comorbidities, ECG results, cardiac pacing indications, implantation data, type of procedure, vein approach, use of temporary stimulation lead, data on the characteristics of the pacemaker and probes, and complications.

Results: six-hundred and-twenty (620) permanent cardiac pacemakers were implanted. That is to say an implantation rate of 41 per million population in Senegal. The mean age of the patients was 71±11.77 years. The male gender was in the majority with a sex ratio of 1.19. Eighty-five percent (n=527) of our patients were symptomatic before implantation while 15% (n=93) were asymptomatic. The symptoms were mainly dyspnea in 41% (n=254), dizziness in 32% (n=322) and syncope in 21.3% (n=132). The most found indication was a complete atrioventricular block in 73.7% (n=457), followed by high-degree AVB in 9.2% (n=57). Sinus dysfunction represented 2.4% of indications (n=15). All devices were purchased by patients themselves or their families without government subsidies. Dual-chamber stimulation was the most used mode in 67.1% (n=416) of the patients. Single-chamber stimulation was also used in 32.9% of cases (n=204). The pacemakers were new in 96.1% of cases (n=596) and reused in 3.9% (n=24). The evolution of our patients was generally favorable. Complications occurred in 4.53% of our patients (n=28); mainly leads dislodgements in 1.94% (n=12), infections in 1.29% (n=8), pocket hematomas in 0.65% (n=4), pneumothorax in 0.65% (n=4).

Conclusion: implantations in Senegal are most often salvage implantations with a predominance of complete atrioventricular blocks over sinus dysfunction. Complications of cardiac pacing in our study were mostly lead dislodgment and infections. The challenges facing cardiac stimulation in our country remain the lack of a national registry for implantation database and above all, a lack of accessibility to pacemakers which may be improved by the availability and use of reused pacemakers but also by the introduction of subsidies for cardiac electronic devices by African governments.