Jun 11, 2018 - 1University Hospital of Douala, Cardiology, Douala, Cameroon; 2Institut ... United Republic of; 4Hopital Laquintinie de Douala, service de ...
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long-stand PAA before, during and after the procedure whereas for 3 (0.3%) pts no PAA was adopted. Local application of antibiotics in the pocket was used in 320 (33%) pts, mainly Rifampicin and Cephalosporins. The most commonly used antibiotics were Cephalosporins (712, 72.4%), followed by Penicillin (171, 17.4%), Vancomycin (43, 4.4%), Fluorochinolons (30, 3.1%), Macrolides (22, 2.2%) and Tetracycline (2, 0.2%). Different suture strategy were used: intradermal absorbable suture in 800 (81.4%) pts, discontinued suture in 292 (29.7%) pts, Sticker in 71 (7.2%) and Stapler in 9 (0.9%) pts. The coagulation strategy during and at the end of the procedure included Electrosurgery (568, 57.8%), Diatermalcoagulation (376, 38.3%), Haemostatic in the pocket (76, 7.7%) and pro-coagulant in the pocket (84, 8.5%). Conclusion: We performed the first systematic investigation of preventive strategies for the prevention of ICD replacement-related infections in current Italian practice. This exploratory analysis of the peri-procedural factors potentially influencing outcomes may improve future practice by providing hints on avoidable risks.
P1073 Epidemiology of sudden cardiac death in sub-saharan africa: a populationbased cohort survey in cameroon A. Ngantcha1; S. Mbouh2; K. Tibarzawa3; C. Saka4; J. Wa5; R. Fonga6; A. Bonny1 University Hospital of Douala, Cardiology, Douala, Cameroon; 2Institut national de la jeunesse et des sport, Universite´ de Yaounde´, Yaounde, Cameroon; 3The Jakaya Kikwete Cardiac Institute, Muhimbili National Hospital,, Dar es Saalam, Tanzania United Republic of; 4Hopital Laquintinie de Douala, service de cardiologie, Douala, Cameroon; 5Hopital de District de Bonassama, Douala, Cameroon; 6Hopital de District de New-Bell, Douala, Cameroon
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On behalf of: PASCAR Task Force on SCD and Arrhythmias Background- The rate of cardiovascular (CV) risk factors is on the rise in subSaharan Africa (SSA), thereby sowing the seeds for the sprawling dissemination of premature cardiac death in this burgeoning African population of patients with CV morbidities. Although being reported, incidence estimates of sudden cardiac death (SCD) in SSA are unknown. Method- During 12 months, the household administrative office and health community committee within neighborhoods in two health areas of Douala, Cameroon, registered all deaths among 86,188 inhabitants aged > 18 years. As part of an extended multi-source surveillance system, the Emergency Medical Service (EMS), local medical examiners and district hospital mortuaries were also surveyed. Whilst two physicians investigated every natural death, two cardiologists reviewed all unexpected natural deaths. Results- There were 288 all-cause deaths. Twentyseven (9.4 %) were SCD (48.1% women). The crude incidence rate was 31.3 (95 % CI: 20.3 to 40.6)/100 000 person-years. The age-standardized rate by the African standard population was 33.6 (95 % CI: 22.4 to 44.9)/100 000 personyears. The median age of victims was 46 years and the number of SCD in persons aged> 40 years was not greater than those < 40 years. Death occurred at night in 37 % cases, including 11 % of patients who died while asleep. One non-competitive female athlete aged 35 years died while exercising. Out-of hospital sudden cardiac arrest occurred in 63 % of cases, 55.5 % of which occurred at home. Of the 89 % cases of witnessed cardiac arrest, 63 % occurred in the presence of a family member, 21% of cases were found dead (or presumably so) at the scene and brought directly to a mortuary, and 42% of agonal victims were transported by taxi/cab to emergency care centers without any resuscitation attempts and cardiopulmonary resuscitation was attempted only in 3.7 %. Hypertension and diabetes were known to be present in 22.2 % and 11.1 % of victims respectively. One 65-year-old man experienced witnessed chest pain consistent with an acute coronary syndrome before he lost consciousness. Heart failure was diagnosed in 4 (14.8 %) patients. ECG recording was not available in any cases, and 2-D Echo was available in only 2 patients but no data of left ventricular ejection fraction was registered. Conclusion- The burden of SCD in this African population is heavy with distinct characteristics, while awareness of SCD and the need for prompt resuscitation appear suboptimal. Larger epidemiological studies are required to establish the real burden in SSA and implement specific preventive strategies targeting the most vulnerable groups of young people and women.
activities throughout Africa. Material and Method A questionnaire regarding activities from 2011 to 2014 was sent to EP physicians. Additional information was obtained through manufacturers or local distributors. Results Thirty-one countries were surveyed. Six countries (19%) did not have any pacemaker activity, and 2 countries (6%) were dependent on visiting experts. No country had a centralized national registry. Among the 25 countries (80%) with facilities for implanting cardiac devices, cardiac resynchronization therapy (CRT) was performed in 9 (36%), implantable cardioverterdefibrillator (ICD) in 12 (48%), and EP procedures in 7 (28%) countries. Only 5 (20%) countries offered the full complements of EP services (pacemaker, CRT, ICD, simple and complex ablation procedures), with only none from sub-Saharan Africa. Per million inhabitants, median number of centers was 3 (1 to 60) and implanting physicians was 9 (2 to 173). The implant rates per million habitants was 36.7 (0.2 to 218). Reused devices were implanted in 6 (37.5%) countries; accounting for up to 7.3% of all procedures. The patient charges for dual-chamber (DDD) pacemaker implantation ranged from $ 0,00 (in countries with reimbursement policies) to $ 5,556 (in private clinics) with the median cost of $2570. Wide variation cost was observed across the countries, with a high inter-center variability. An inverse correlation between implant rates per million inhabitants and the procedure fees standardized to the Gross Domestic Product per habitants (Correlation Coefficient r2¼ -0.17) was found. Conclusion Due to the high cost of procedures in the settings of pay-out-of-pocket healthcare policies, pacemaker implantations are still suboptimal in this low incomes part of the world, mainly in sub-Saharan Africa. EP procedures are in their embryonic stages and need to be developped through South-North fellowship programs.
SCIENTIFIC DOCUMENTS AND GUIDELINES P1075 Risk classification for sudden cardiac death in japanese hypertrophic cardiomyopathy patients with implantable cardioverter-defibrillator in comparison between aha, jcs and esc guideline M. Nakano1; Y. Kondo2; M. Nakano1; K. Miyazawa1; T. Hayashi1; Y. Kobayashi1 Chiba University Graduate School of Medicine, Department of Cardiovascular Medicine, Chiba, Japan; 2Chiba University Graduate School of Medicine, Department of Advanced Cardiovascular Therapeutics, Chiba, Japan
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Background: Patients with hypertrophic cardiomyopathy (HCM) are at high risk of lethal arrhythmia, i.e. ventricular tachycardia/fibrillation, and implantable cardioverter defibrillators (ICD) are widely used for prevention of sudden cardiac death. There are few reports about the clinical predictive factor which the appropriate ICD therapies produces, and in regard to the adaptation of the ICD there is a difference in Japan and European and American guidelines, and it remains to be controversial. Objection: The aim of this study is to examine the appropriate shocks of ICD in Japanese patients with HCM and evaluate validity of the risk stratification of SCD by the 2014 ESC guideline. Methods: The subjects of the study were HCM patients who have ICD implanted from Oct 2006 to Aug 2015 collected from patient database of our Hospital retrospectively. We analyzed the characteristics of and outcomes for patients with ICD in all cases, and we investigated the occurrence frequency of appropriate shock of ICD according to the classes distributed based on ESC guideline. Results: A total of consequence 57 HCM patients with ICD were enrolled in this study. All the patients meet class I or IIa in the guideline in Japan and the U.S.. Over a mean follow-up period of 51627months, 8 patients (11%) received appropriate ICD therapies. The outcomes of the patients were shown in the table, respectively. Conclusions: Our study suggested that SCD risk stratification by ESC guideline is validated in Japanese HCM patients, and the guideline might be useful for adaptation of ICD implantation in Japan.
P1074 Managing arrhythmias in africa: the pan african society of cardiology (PASCAR) survey on the use of cardiac electronic devices and electrophysiological procedures from 2011 to 2014 in 31 countries M. Ngantcha1; E. Okello2; K. Tibarzawa3; R. Houndolo4; K. Bundhoo5; F. Goma6; M. Ouankou7; A. Chin8; A. Bonny1 1 University Hospital of Douala, Cardiology, Douala, Cameroon; 2Mulago Hospital, University of Makerere, Department of cardiology, kampala, Uganda; 3The Jakaya Kikwete Cardiac Institute, Muhimbili National Hospital,, Dar es Saalam, Tanzania United Republic of; 4Hopital Aristide Le Dantec , service de Cardiologie, Dakar, Senegal; 5Rose Hill General Hospital , Department of cardiology, Mauritius, Mauritius; 6 UNZA School of Medicine, Department of cardiology, Lusaka, Zambia; 7Centre de cardiologie du Dr Ouankou, Yaounde, Cameroon; 8University of Cape Town, Grooshur Hospital, Department of cardiology, Cape Town, South Africa On behalf of: PASCAR Task Force on SCD and Arrhythmias
Abstract P1075 Figure.
Background: Lack of data on cardiac electronic devices and electrophysiological (EP) procedures in Africa is impeding the formulation of appropriate health policies on the managing cardiac arrhythmias. We conducted a survey on pacing and EP
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