Implantation of pacemakers and defibrillators: feedback of the first Congolese experience of an analytic case series

Abstract

Context and objective. Cardiac stimulation is a widespread and vital treatment worldwide for major conduction and excitability disorders. However, its practice in the Democratic Republic of Congo (DRC) is recent. The aim of this work was to present the first cases of cardiac pacing performed by a local team in the DRC. Methods. This multicenter analytical case series study described the implantation procedures and the characteristics of patients who benefited from pacemakers (PM) or implantable cardioverter defibrillators (ICD) in the Democratic Republic of Congo. Results. A total of 88 patients underwent the PM or ICD implantation procedures. Their average age was 69.5±9.3 years with 54.5% men. Dyspnea (47%) and syncope (28%) were their major complaints and 3rd degree atrioventricular block (AVB) (68.3%) their main reason for implantation. The cephalic approach was the most used (56.8%) and 74% of PMs were dual chamber. Acute complications (19.3% of cases) consisted of bleeding (6%), convulsions (5%) and probe repositioning (3%); post-operative (8%) with pacemaker syndrom (2%), lead displacement (1%) and infection requiring complete extraction of the material (1%). Chronic kidney disease (OR=1.3[95% CI: 0.87-9.04];p=0.16) and hypertension (2.45[1.13-8.9]; p=0.01) increased the risk of acute complications, while age ≥65 years (1.78[1.11-16.2];p=0.02), male gender (2.49 [1.74-46.1];p=0.001), the use of anticoagulants/antiplatelets (1.66 [1.16-18.6];p=0.028) and an LVEF≤35% (3.08[1. 10-36.03];p=0.024) those of subacute complications. Conclusion. The practice of cardiac stimulation in the DRC is effective. The cephalic approach is the most practiced; dual-chamber devices are the most used and complications are rarely encountered. Received: July 8th, 2024 Accepted: October 16th, 2024 https://dx.doi.org/10.4314/aamed.v18i1.4