Using reconditioned pacemakers to treat bradycardia in Africa

Wunderly, Kevin; Yousef, Zaheer; Bonny, Aimé; Weatherwax, Kevin; Lavan, Balasundaram; Allmendinger, Craig; Wasserman, Brad; Samson, George; Davis, Sheldon; Nel, George; Russell, James; Akwanalo, Constantine; Sani, Mahmoud U; Chin, Ashley; Ajijola, Olujimi A.; Mayosi, Bongani M.; Eagle, Kim A.; Crawford, Thomas

doi:10.1038/s41569-018-0076-y

Cited by 11 publications

(12 citation statements)

References 10 publications

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“…Three identified main barriers to pacemaker and ICD implantation in SSA are reduced availability of implanting facilities with appropriate equipment, deficits in trained clinical specialists, and high cost of the devices and their accessories in the setting of high pay-out-of-pocket policies [9,12,106,107,141]. An interim solution to the high cost of cardiac devices is the re-use of previously implanted and explanted devices donated from the developed world, the so-called postmortem pacemakers and defibrillators, which have been shown to be safe in SSA [107,116,141,142] and worldwide [138,143], and their use has been backed by electrophysiology specialists [144]. Despite earlier observation of underuse of these recycled cardiac devices in SSA [12], growing partnerships between PASCAR and My Heart Your Heart (University of Michigan, USA) as well as Pace 4 Life (UK-based charity organisation) are now helping to bring more of these reconditioned CIEDs to SSA [9,141].…”

Section: Post-mortem or Reusable Ciedsmentioning

confidence: 99%

“…An interim solution to the high cost of cardiac devices is the re-use of previously implanted and explanted devices donated from the developed world, the so-called postmortem pacemakers and defibrillators, which have been shown to be safe in SSA [107,116,141,142] and worldwide [138,143], and their use has been backed by electrophysiology specialists [144]. Despite earlier observation of underuse of these recycled cardiac devices in SSA [12], growing partnerships between PASCAR and My Heart Your Heart (University of Michigan, USA) as well as Pace 4 Life (UK-based charity organisation) are now helping to bring more of these reconditioned CIEDs to SSA [9,141]. Given the palpable clear life-saving contribution of CIEDS, fostering partnerships and encouraging the re-use of CIEDS donated from the developed countries, plus initiatives aimed at building acceptable implanting centers and training specialists even through short and tailored fellowships [106], are of paramount importance and urgency.…”

Section: Post-mortem or Reusable Ciedsmentioning

confidence: 99%

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

Yuyun

Bonny

et al. 2020

Global Heart

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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.

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Section: Post-mortem or Reusable Ciedsmentioning

confidence: 99%

Section: Post-mortem or Reusable Ciedsmentioning

confidence: 99%

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

Yuyun

Bonny

et al. 2020

Global Heart

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“…However, actually and for previously mentioned reasons, CIED reuse should only be considered in situations where benefits outweigh potential risks and these are adequately informed to the recipient patient 28,43 . Likewise, it is important to guarantee a quality reconditioning and traceability of reprocessed devices and a rigorous follow‐up of patients who receive a reprocessed device 14 . Therefore, implanting hospitals in developing countries must assure that reprocessed CIEDs are only offered to patients who cannot afford a new device, as well as informing them about the risks of reprocessed devices and collecting the respective informed consent before reimplantation 43 …”

Section: Discussionmentioning

confidence: 99%

“…In recent years, the literature and interest regarding reprocessing used CIEDs as an alternative to new ones has increased 13–15 . CIEDs are classified as single‐use medical devices, and their reprocessing for reimplantation entails risks, for example, device infection or malfunction 16 .…”

Section: Introductionmentioning

confidence: 99%

Reuse of cardiac implantable electronic devices in developing countries perspectives: A literature review

Ruiz

2021

Pacing Clinical Electrophis

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Introduction and Objectives Access to cardiac implantable electronic devices (CIEDs) is limited in developing countries. Postmortem CIED donation from developed countries to developing countries could be an important resource for those who cannot afford a new one. The objective of this paper was to identify and synthesize the perspectives on the donation of CIEDs for potential reuse in patients without resources living in developing countries. Methods A bibliographic review was carried out in the PubMed, Web of Science and Scopus databases. The search strategy was limited to articles published in English or Spanish. Results Eight publications were analyzed. The main results were grouped into two large frameworks on perceptions, preferences, attitudes and opinions of developed countries and developing countries towards the donation and reuse of CIEDs. Positive perspectives were identified towards the donation of CIEDs for their reuse in the majority of patients with a CIED, relatives, funeral homes and physicians of developed countries, as well as in physicians and potential recipient patients of developing countries. Conclusions This review highlights the positive perspectives on CIED donation from developed countries to patients in need of developing countries among all studied groups. In view of the feasibility of collecting postmortem devices, we advocate studying the feasibility of more local CIED donation initiatives.

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“…At rest, heart rate is maintained at approximately 60-100 beats per minute by innervation of the parasympathetic nervous system [1]. Elevated parasympathetic activity via constant stimulation of the Vagus nerve will yield a significant decline in heart rate, known clinically as bradycardia [2,3]. The right branch of the Vagus nerve inhibits the SA node, or the cardiac pacemaker, while the left branch of the Vagus nerve inhibits the AV node [2].…”

Section: Opinionmentioning

confidence: 99%

Normotensive vs Hypertensive: Blood Pressure Response During Incremental Exercise

Jaffe

Hewit

Crowder

2018

RISM

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Using reconditioned pacemakers to treat bradycardia in Africa

Cited by 11 publications

References 10 publications

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

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

Reuse of cardiac implantable electronic devices in developing countries perspectives: A literature review

Normotensive vs Hypertensive: Blood Pressure Response During Incremental Exercise

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