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

Abstract

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 non-invasive (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.

Keywords

• atrial arrhythmias
• supraventricular tachycardia
• sudden cardiac death
• ventricular arrhythmias
• pacemaker
• defibrillator
• sub-saharan africa