[Psycho-social experiences and quality of life of pacemaker patients in Cotonou]. / Vécu psycho-social et qualité de vie des patients porteurs de pacemaker à Cotonou.

PURPOSE OF THE STUDY: The aim was to study the psycho-social experiences and quality of life (QOL) of pacemaker patients at the National Teaching Hospital Hubert Koutoukou Maga in Cotonou. PATIENTS AND METHOD: A descriptive cross-sectional observational study was performed in 2017 and included over a three-month period all pacemaker patients admitted on an ambulatory basis. The psychological impact of wearing a pacemaker was studied, as well as the limits and constraints of daily life and the quality of life appreciated by the SF-36 score. RESULTS: Fifty-five (55) patients were included with an average age of 67 ± 11.3 years. In terms of psychological impact, 98.2% (n=54) had a good overall perception of their health status. However, 60.6% (n=33) perceived pacemaker use as a handicap and 52.5% (n=29) wanted psychological support in post-implantation. Limitations and constraints mainly concerned lateral decubitus on the side of the pacemaker (54.5%, n=30), travel (27.3%, n=15) and sexual relations (21.8%, n=12). The average quality of life was rated good in 6 out of 8 dimensions. The level of quality of life was independent of gender. CONCLUSION: This study has highlighted misperceptions of daily life that may hinder the expected improvement in post-implantation patient performance. Psychological support and enhanced communication with these patients are needed.

Detection of a Left Superior Vena Cava during a Pacemaker Implantation in Cotonou.

Persistent left superior vena cava (LSVC) is a rare congenital anomaly. Its prevalence in the general population is 0.1 to 0.5%. LSVC is 5 times rarer when accompanied by an absence of the right superior vena cava (RSVC). We present the case of a 54-year-old man who carries a persistent LSVC without RSVC. Clinically, this patient presented a regular bradycardia at 40 per minute associated with a heart failure syndrome. The electrocardiogram diagnosed a complete atrioventricular block and transthoracic echocardiography showed dilated left heart cavities and a left ventricular ejection fraction of 50%. During the procedure of pacemaker implantation, the probe followed an unusual LSVC-coronary sinus-right atrium path and it was not easy to pass through the tricuspid orifice. We propose a review of the literature on this subject, focusing on the clinical implications of this malformation in cardiac stimulation and in other areas of cardiology.

[Loss of capture by myocardial ischemia: A case report]. / Perte de capture par ischémie myocardique : à propos d'un cas.

We report the case of a patient with pacemaker who presented chest pain during exercise followed by fainting. He has a history of arterial hypertension and diabetes. The initial examination was normal; the ventricular stimulation threshold was 1.125 volts (V) and cardiac enzymes were normal. Stress test has reproduced chest pain followed by loss of pacemaker capture and asystole. Coronary angiography showed a tight stenosis of the proximal anterior interventricular artery dilated by a drug-eluting stent. The control of stress test was normal. A stent thrombosis eight days later led to an acute coronary syndrome with recurrent syncope due to the loss of ventricular capture. The ventricular pacing threshold was then 2.25V. After revascularization and stabilization of the patient's clinical status, this threshold returned to 1.125V. This clinic case has confirmed that coronary artery disease could increase pacing threshold. It also highlights the usefulness of automatic capture algorithms in coronary patients. The stress test cannot only help to detect coronary artery disease but also allows the optimization of programming the pacemaker.

Valeur pronostique péri-opératoire des anomalies de la repolarisation ventriculaire découvertes sur l'ECG pré-opératoire au Centre Hospitalier et Universitaire de Cotonou

But : Le but de cette étude était de déterminer la valeur pronostique des anomalies de la repolarisation ventriculaire découvertes sur l'ECG réalisé avant la chirurgie non cardiaque. Méthode : Cette étude prospective effectuée sur une période de 10 mois a inclus des patients âgés de 18 ans au moins ayant réalisé un ECG préopératoire interprété par un cardiologue. Ces patients ont été suivis pendant l'intervention et jusqu'à H48 après. Les évènements cardiovasculaires anormaux étaient enregistrés pendant l'intervention et les deux premiers jours post-opératoires.Résultats : Quatre-vingt-dix-sept (97) patients ont été inclus. Les anomalies de la repolarisation ont été retrouvées chez 58,8% des patients. L'aspect d'ischémie sous-épicardique et la repolarisation précoce étaient les anomalies de la repolarisation les plus fréquentes avec des fréquences respectives de 42,3% et 14,4%. L'hypotension artérielle était l'évènement cardiovasculaire le plus retrouvé en per-opératoire devant la tachycardie sinusale, la poussée hypertensive, le choc cardiogénique et l'accélération de la fibrillation atriale. L'hypotension artérielle était le seul évènement cardiovasculaire péjoratif en per-opératoire, associé aux anomalies de la repolarisation avec un test statistiquement significatif (55,4% versus 32,5% ; p = 0,02). La période post-opératoire a été marquée par la survenue de deux (2) décès dans le groupe des patients ayant présenté une anomalie de repolarisation.Conclusion : L'ECG des patients subissant une chirurgie non-cardiaque contient des informations pronostiques importantes. Les résultats de notre étude montrent que l'ischémie sous-épicardique doit être considérée comme un facteur de risque indépendant d'hypotension per opératoire

Basic principles for evaluation of less deformable erythrocyte subpopulations with the Microfiltrometer.

The Microfiltrometer consists of a filtration system for diluted erythrocyte suspensions, through a filter containing 30 cylindrical micropores, 5 microm in diameter, under the influence of a driving pressure. A feeding sinusoidal alternating current of 40 kHz, 300 microA is delivered to the filter. The change in impedance is collected for each temporary flow of erythrocytes through a given micropore. Two main parameters are measured for individually explored erythrocytes: the entry time tau in the micropore and the maximal variation of impedance deltaZ occurring for the transitory flow. The slope deltaZ/tau defines the velocity of pore blockage. A "Microfiltrometer Deformability Index" (MDI) is established by using this slope. When MDI > or = 1, the erythrocyte is considered to be deformable and, conversely, when MDI < 1, the erythrocyte is considered to be undeformable. Using this procedure, less than 2% undeformable erythrocytes in healthy blood samples are identified, with a specificity of 99% and a sensitivity of 97.5%.