Baseline Profile, Rhythm Abnormalities and Outcomes for Patients With Pacemakers Inserted at the Kenyatta National Hospital

Abstract

Keywords: pacemaker, rhythm abnormalities, indications, outcomes, Kenyatta Background: Permanent pacemakers are the only treatment for high degree atrioventricular block or symptomatic bradycardia. Quadrennial surveys by the World Society of Arrhythmias have demonstrated a rise in the uptake of device therapy worldwide. However there is limited data on pacemaker use in Sub-Saharan Africa including Kenya. Objectives: The aim of this study was to determine the baseline clinical characteristics, rhythm abnormalities at presentation and the outcomes for patients who underwent pacemaker insertion at the KNH between 1st January 2011 and 31st December 2015. Methodology: This study was a retrospective chart audit based at the records department of the KNH. Patient details were retrieved from a register in the cardiac catheterization laboratory and the matching record searched for. Patients whose records were retrieved and who met the inclusion criteria constituted our study population. The vital status for each patient was then established via a phone call placed to the contacts in their record. Results: Between 2011 and 2015, 359 patients underwent pacemaker insertion at KNH. We retrieved records for 214 patients who formed our study population. We were able to contact 165(77.1%) by phone. Most patients were elderly (median age of 71years) and female (65.4%). The most frequent presentation was dyspnoea (41.6%) and dizziness (29.9%). The commonest co-morbidity was hypertension (64%). The leading indication for pacemaker insertion was complete heartblock in 78%. The pacemaker mode most employed was DDD in 54.2%. Majority of the patients (92.1%) had presented for an index pacemaker insertion. Complications were recorded for 8.9% of patients. The median duration lived with a pacemaker in situ was 3 years and 69.2% of the 214 patients were alive at the time of the study. We confirmed that 7.9% were deceased while the vital status for 22.9% could not be established. Conclusion: The commonest indication for pacemaker insertion at KNH is complete heart block. Most of the patients undergoing the procedure are elderly and hypertensive. Complication rates were comparable to those of developed countries with low infection rates and no mortalities during the procedure.