Characteristic and evolution of pacemaker complications in a Subsaharan Africa Heart Centre

Aim of the study: The working environment and the low rate of pacemaker insertions increase the risk of complications in sub-Saharan Africa. The objective of our work was to assess the impact of specific preventive measures on these complications over the long term. Patient and Methods: We conducted a retrospective study of all pacemaker implantations from June 2006 to June 2016 at the Abidjan Heart Institute. We evaluated the incidence of pacemaker complications, their risks factors and their impact on the overall prognosis of patients. Results: Three hundred and two procedures were performed in 286 patients (49% male, mean age: 67 ± 12 years), with a predominance of primary implantation (82.8%) of single-chamber ventricular pacemakers (66.6%). Twenty-five major complications (8.27%) and 14 minor (4.6%) occurred with a predominance of lead displacements (3.64%). The major complications were favored by the subclavian approach (P = 0.018; OR = 2.34; 95% CI [1.16–4.75]) and intraoperative incidents (P = 0.02; OR = 2.17; 95% CI [1.16–4.75]. The preventive measures taken made it possible to achieve a significant (P = 0.017) and linear (P = 0.009) reduction of these complications, with no effect the patients prognosis (Log-Rank = 0.217; P = 0.64). Conclusion: Quality cardiac stimulation is possible in Sub-Saharan Africa with preventive measures adapted to the environment.