A Systematic Review of the Spectrum of Cardiac Arrhythmias in Sub-Saharan Africa

Abstract

Major structural cardiovascular diseases are associated with cardiac arrhythmias, but their full spectrum remains unknown in sub-Saharan Africa (SSA), which we addressed in this systematic review. Atrial fibrillation/atrial flutter (AF/AFL) prevalence is 16-22% in heart failure, 10-28% in rheumatic heart disease, 3-7% in cardiology admissions, but <1% in the general population. Use of oral anticoagulation is heterogenous (9-79%) across SSA. The epidemiology of sudden cardiac arrest/death is less characterized in SSA. Cardiopulmonary resuscitation is challenging, owing to low awareness and lack of equipment for life-support. About 18% of SSA countries have no cardiac implantable electronic devices services, leaving hundreds of millions of people without any access to treatment for advanced bradyarrhythmias, and implant rates are more than 200-fold lower than in the western world. Management of tachyarrhythmias is largely noninvasive (about 80% AF/AFL via rate-controlled strategy only), as electrophysiological study and catheter ablation centers are almost non-existent in most countries. Highlights:-Atrial fibrillation/flutter prevalence is 16-22% in heart failure, 10-28% in rheumatic heart disease, 3-7% in cardiology admissions, and <1% in the general population in sub-Saharan Africa (SSA).-Rates of oral anticoagulation use for CHA2DS2VASC score ≥2 are very diverse (9-79%) across SSA countries.-Data on sudden cardiac arrest are scant in SSA with low cardiopulmonary resuscitation awareness.-Low rates of cardiac implantable electronic devices insertions and rarity of invasive arrhythmia treatment centers are seen in SSA, relative to the high-income countries.

Prévalence de la fibrillation atriale non valvulaire et de l´accident vasculaire cérébral ischémique et facteurs associés à la fibrillation atriale non valvulaire chez les patients hypertendus: étude observationnelle à propos de 2887 patients

“…L´HTA constitue un facteur de risque puissant et indépendant de survenue de FA non valvulaire [ 4 ]. La prévalence de la FA dans la population générale est estimée entre 1 et 2% [ 2 , 6 ]. Conformément à ce qui a été trouvé dans notre étude, la prévalence augmente chez les patients présentant certains facteurs de risque tels que l´HTA [ 3 , 7 ].…”

Ocorrência de arritmias ventriculares e supraventriculares de acordo com o perfil clínico de pacientes renais crônicos em hemodiálise: estudo no Real Hospital Português de Pernambuco

“…Isso pode estar relacionado pelo fato de muitos pacientes serem subdiagnosticados quanto à necessidade de utilizarem esses medicamentos, mostrando a importância do registro eletrocardiográfico (Holter) nesses pacientes (Yuyun et al, 2020).…”

Capacity Building for the Diagnosis and Management of Cardiac Arrhythmias in Africa

“…In Africa, the rate of CA increased gradually following the epidemiological transition of diseases [3]. According to a recent systematic review conducted by Matthew F. Yuyun et al, there are few available health professionals who can adequately manage CA in Africa [4]. In fact, the cardiopulmonary resuscitation awareness for the management of cardiac arrest is generally low and there is scarcity of cardiac implantable electronic devices insertions and invasive arrhythmia treatment centers [4].…”

“…According to a recent systematic review conducted by Matthew F. Yuyun et al, there are few available health professionals who can adequately manage CA in Africa [4]. In fact, the cardiopulmonary resuscitation awareness for the management of cardiac arrest is generally low and there is scarcity of cardiac implantable electronic devices insertions and invasive arrhythmia treatment centers [4]. Bonny et al in 2019 identified the low number of trained clinicians who could detect and manage CA [5].…”