Cardiac Pacing Training in Africa: Endorsed by the Africa Heart Rhythm Association (AFHRA): JACC International.

The field of pacing in Africa has evolved in an uncoordinated way across the continent with significant variation in local expertise, cost, and utilization. There are many countries where pacemaker services do not meet one-hundredth of the national demand. Regional, national, and institutional standards for pacemaker qualification and credentials are lacking. This paper reviews the current needs for bradycardia pacing and evaluates what standards should be set to develop pacemaker services in a resource-constrained continent, including the challenges and opportunities of capacity building and training as well as standards for training programs (training prerequisites, case volumes, program content, and evaluation).

A multi-sectoral, non-governmental program for control of rheumatic heart disease: SUR I CAAN: A model for developing countries.

Rheumatic heart disease (RHD) is a leading cause of cardiovascular mortality in developing countries. Control of RHD requires addressing the disease at its different stages through health system variables that are complex and intersecting. To achieve that, a multi-sectoral program is needed that is best implemented through ministries of health. In this report we present the SUR I CAAN program (Surveillance, Integration, Communication, Awareness, Advocacy and Training) that is implemented in Sudan utilizing nongovernmental resources and nonconventional funding. The program objectives are: 1. To improve primary, secondary and tertiary prevention of RHD, 2. To improve public awareness, 3. To implement strategic research projects, and 4. To improve advocacy through collaboration with regional and international organizations dealing with RHD. We established a hospital-based register and managed to identify high burden areas where sentinel sites for RHD control were established. A package of training and awareness material was utilized to conduct training workshops in these areas. Handheld echocardiography was utilized for studying the prevalence as well as for early detection and treatment of RHD. Although we did not conduct a structured evaluation for this program, we believe that its structure can serve as a model for other resource-limited countries.

Cardiac arrhythmia services in Africa from 2011 to 2018: the second report from the Pan African Society of Cardiology working group on cardiac arrhythmias and pacing.

AIMS: Cardiac arrhythmia services are a neglected field of cardiology in Africa. To provide comprehensive contemporary information on the access and use of cardiac arrhythmia services in Africa. METHODS AND RESULTS: Data on human resources, drug availability, cardiac implantable electronic devices (CIED), and ablation procedures were sought from member countries of Pan African Society of Cardiology. Data were received from 23 out of 31 countries. In most countries, healthcare services are primarily supported by household incomes. Vitamin K antagonists (VKAs), digoxin, and amiodarone were available in all countries, while the availability of other drugs varied widely. Non-VKA oral anticoagulants (NOACs) were unequally present in the African markets, while International Normalized Ratio monitoring was challenging. Four countries (18%) did not provide pacemaker implantations while, where available, the implantation and operator rates were 2.79 and 0.772 per million population, respectively. The countries with the highest pacemaker implantation rate/million population in descending order were Tunisia, Mauritius, South Africa, Algeria, and Morocco. Implantable cardioverter-defibrillator and cardiac resynchronization therapy (CRT) were performed in 15 (65%) and 12 (52%) countries, respectively. Reconditioned CIED were used in 5 (22%) countries. Electrophysiology was performed in 8 (35%) countries, but complex ablations only in countries from the Maghreb and South Africa. Marked variation in costs of CIED that severely mismatched the gross domestic product per capita was observed in Africa. From the first report, three countries have started performing simple ablations. CONCLUSION: The access to arrhythmia treatments varied widely in Africa where hundreds of millions of people remain at risk of dying from heart block. Increased economic and human resources as well as infrastructures are the critical targets for improving arrhythmia services in Africa.

PASCAR and WHF Cardiovascular Diseases Scorecard project.

On behalf of the World Heart Federation, the Pan-African Society of Cardiology (PASCAR) co-ordinated data collection and reporting for the country-level Cardiovascular Diseases (CVD) Scorecard to be used in Africa. The objective of the scorecard is to create a clear picture of the current state of CVD prevention, control and management per country for 12 African countries. The Sudan Heart Society assisted PASCAR in collating and verifying the data through Drs Awad Mohamed (president, Sudan Heart Society) and Saad Subahi (PASCAR president, based in Sudan). Based on the data collected, we summarise the strengths, threats, weaknesses and priorities identified, which need to be considered in conjunction with the associated sections provided in the infographic published with this report. Data sets used included open-source data from the World Bank, World Health Organisation and government publications.

Evaluation of cardiac sources of embolism

Cerebrovascular disease is a leading cause of mortality and morbidity .20% of cerebral infarcts are due to cerebral embolism of cardiac origin. Conditions associated with cardiogenic emboli are either rhythm abnormalities such as atrial fibrillation (AF) responsible for 50% , or structural abnormalities .Whereas left ventricle thrombus ,left atrium thrombus ,vegetation , tumor and protruding atherosclerotic plaque are considered as direct sources of embolization , others such as valvular disease , wall motion abnormality , atrial septal defect (ASD) , patent foramen ovale(PFO) , atrial septal aneurysm (ASA) and spontaneous echocardiographic contrast (SEC) are considered as indirect cardiac sources of embolization . In this article evaluation of cardiacsources of embolism and the role of echocardiography are discussed. Though both transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) play an important role,TEE appears to be more sensitive in identifying potential abnormalities in patients with suspected cardiac sources of emboli

Diagnosis of Supravalvular Aortic Stenosis by Transesophageal Echocardiography.

The role of transesophageal echocardiography (TEE) in diagnosis of disorders of the thoracic aorta is well established. In this report the TEE findings in an adult patient with supravalvular aortic stenosis are presented. This showed narrowing of the ascending aorta just above the sinuses, due to fibromuscular thickening, causing an hour-glass shaped deformity. The excellent image quality obtained by TEE is far superior to transthoracic echocardiography. Coronary artery ostial obstruction a known association of supravalvular aortic stenosis can be caused by different mechanisms including adherence of the aortic valve leaflet to the ridge of obstructive muscle or premature atherosclerosis. TEE can define the mechanism of coronary artery ostial obstruction associated with supravalvular aortic stenosis.

Acquired Intercostal Arteriovenous Fistulas: Transesophageal Doppler Echocardiographic Diagnosis.

Acquired intercostal arteriovenous fistulas are recognized complications of traumatic injuries. In this article, transesophageal Doppler echocardiographic findings in a patient with posttraumatic acquired intercostal arteriovenous fistulas are presented. The findings have been confirmed by angiography. The demonstration of intercostal arteriovenous fistulas by transesophageal Doppler echocardiography has not been reported before. (ECHOCARDIOGRAPHY, Volume 13, November 1996)