Long-term prognosis of patients with permanent cardiac pacemaker indication in three referral cardiac centers in Cameroon: Insights from the National pacemaker registry.

BACKGROUND: There is evidence that cardiac pacemakers improve symptoms and quality of life in patients with severe bradycardia. Globally, the number of pacemaker implantations is on the rise. However, the associated high-cost limits pacemaker's accessibility in low resource settings. This study aimed to investigate access to pacemakers and the long-term outcome of patients requiring a pacemaker. METHOD: We conducted a cohort study in 03 health care structures in Cameroon. Participants aged at least 18 years with indication for a permanent pacemaker between January 2010 and May 2016 were included. Clinical profile, electrocardiography, pacemaker implantation parameters were recorded. Long-term survival was studied by event-free analysis using the Kaplan-Meier method. RESULTS: In total, 147 participants (mean age 67.7±13.7 years, female 58.5%) were included. Fatigue (78.7%), dyspnoea (77.2%), dizziness (47.1%) and palpitations (40.4%) were the main symptoms while syncope was present in 35.7% of patients. The main indication for cardiac pacemaker was atrioventricular block (85.3%). Forty (27.2%) could not be implanted with 34 (85%) of participants highlighting cost of intervention as main reason. VVIR was the main mode of stimulation (70.5%). Of 125 patients in which follow-up was ascertained, 17(13.5%) died after a median survival time of 2.8 years post diagnosis [IQR: 1.8-4.2]. The survival curve was better in participants with a pacemaker with a Hazard ratio of 2.7 [CI: 1.0-7.3, P=0.045]. CONCLUSION: Our patients with severe heart blocks presented late and more than a quarter did not have access to pacemaker but its implantation multiplied the survival rate by 2.7 times at approximately 3 years post diagnosis. Improving early detection of heart blocks and access to cardiac pacing to reduce mortality shall be a key future priority.

Cardio-embolic stroke: Lessons from a single centre in Sub-Saharan Africa.

BACKGROUND: Limited information is available about cardio-embolic stroke (CES) in sub-Saharan Africa. The aim of this study was to describe the epidemiology, clinical features, etiology, the management and outcome of CES in our setting. METHODS: A retrospective cohort study was carried out in the Douala General Hospital (DGH), using files of ischemic stroke patients admitted in the Neurological Unit and the Intensive Care Unit. Socio-demographic, clinical and paraclinical data were collected. After hospitalization, follow-up was performed with focus on mortality, stroke recurrence and the functional outcome assessed with Barthel score. Multivariate analysis was performed to determine the factors associated with death. RESULTS: Of the 704 stroke cases included, 368 were ischemic with 86 (23.4%) of them being cardio-embolic. The mean age of patient with CES was 67±13.3 years. The main etiologies of CES were: atrial fibrillation (82.1%), dilated cardiomyopathy (12.8%), and rheumatic mitral stenosis (5.1%). Anti-platelet agents were the most prescribed anti-thrombotic drugs (50.7%). The in-hospital mortality rate was 23.3% with lesion in both internal carotid arteries [OR=110.3; 95% CI: 1.2-1040.7; P=0.043] and heart disease [OR=46.9; 95% CI: 1.2-1789.9; P=0.038] appeared to be predictive of this. Stroke recurrence was observed in 8 patients (12.1%) and the survival probability in 5 years was 10%. Functional outcome was progressively worse with the systolic blood pressure>140mmHg (P=0.025) been the associated factor. CONCLUSION: CES accounted for 1/4 of ischemic stroke with a high risk of early death and long-term recurrence. Atrial fibrillation was the leading cause of CES. The association of VKA and anti-platelet agent should be avoided to reduce early death during acute stroke.