Factors Associated With Non-Uptake of Implantable Cardioverter-Defibrillator (ICD) Among Eligible Patients at a Tertiary Hospital in Kenya.

Background: Efficacy of Implantable Cardioverter-Defibrillator (ICD) implantation in both primary and secondary prevention of Sudden Cardiac Death (SCD) in at-risk population is well established. ICD implantation rates remain low particularly in Africa with a paucity of data regarding factors associated with non-uptake.

Objectives: The primary study objective was to determine the factors associated with non-uptake of ICD among heart failure (HF) patients with reduced ejection fraction (EF<35%).

Acute coronary syndrome patterns in the Young: risk factor profile and in-hospital outcomes in a tertiary referral hospital in Kenya.

Introduction: Acute coronary syndrome (ACS) accounts for coronary artery disease (CAD) -related morbidity and mortality. There has been growing concern about the rising incidence of ACS among young individuals globally both in developed and developing countries, including Sub-Saharan Africa. This group's phenotypic characteristics; risk factors and clinical outcomes are not well described.

Burden of bradycardia and barriers to accessing bradycardia therapy in underserved countries.

Bradycardia, a condition characterized by an abnormally slow heart rate, poses significant challenges in terms of diagnosis and treatment. While it is a concern world-wide, low- and middle-income countries (LMICs) face substantial barriers in accessing appropriate bradycardia therapy. This article aims to explore the global aetiology and incidence of bradycardia, compare the prevalence and management of the condition in high-income countries versus LMICs, identify the key reasons behind the disparities in access to bradycardia therapy in LMICs, and emphasize the urgent need to address these disparities to ensure equitable healthcare on a global scale.

Improving implant training for physicians and their teams in under-represented regions.

The burden of cardiovascular disease is increasing globally, with low- and middle-income countries (LMICs) absorbing most of the burden while lacking the necessary healthcare infrastructure to combat the increase. In particular, the disparity in pacemaker implants between high-income countries and LMICs is glaring, partially spurned by reduced numbers of physicians and supporting staff who are trained in pacemaker implant technique. Herein, we will discuss current pacemaker implant training models, outline training frameworks that can be applied to underserved regions, and review adjunctive training techniques that can help supplement traditional training models in LMICs.

Predictors of Coronary Artery Disease in Heart Failure with Reduced Ejection Fraction at the Aga Khan University Hospital in Nairobi.

Unlabelled: There appears to be an epidemiological transition in the etiology of heart failure in sub-Saharan Africa (SSA) in parallel with a steady increase in risk factors for coronary artery disease (CAD). SSA has limited access to heart failure and CAD diagnostics, limiting the number of patients who receive optimal care. Our objectives were to study the predictors of coronary artery disease among patients with heart failure with reduced ejection fraction (HFrEF) and develop a model to assist clinicians in determining the likelihood of CAD before cardiac catheterization.

Assessment of Cardiac, Vascular, and Pulmonary Pathobiology In Vivo During Acute COVID-19.

Background Acute COVID-19-related myocardial, pulmonary, and vascular pathology and how these relate to each other remain unclear. To our knowledge, no studies have used complementary imaging techniques, including molecular imaging, to elucidate this. We used multimodality imaging and biochemical sampling in vivo to identify the pathobiology of acute COVID-19.

The joint 15th Pan-African Society of Cardiology and Kenya Cardiac Society congress proceedings, 2021.

The 15th biennial Pan-African Society of Cardiology (PASCAR) congress held in Mombasa, Kenya, in November 2021, convened in its legacy of being the largest Pan-African conference on cardiovascular diseases (CVDs). The congress brough together members of cardiovascular societies from across the continent in the shared mission of advancing cardiovascular health in Africa. In partnership with the Kenyan Cardiac Society (KCS), the specific aims of the PASCAR conference were to (1) advance knowledge on CVDs in the region; (2) share local data, clinical cases, challenges and solutions and reinforce collaborative capacity initiatives in research and workforce training; (3) engage with policy makers to address health-system issues affecting access to CVD care in Africa; and (4) bring together local and international thought leaders in cardiovascular medicine to strengthen the partnerships between PASCAR, KCS, other African cardiac societies and key global stakeholders.

Cardiovascular risk factors and markers of myocardial injury and inflammation in people living with HIV in Nairobi, Kenya: a pilot cross-sectional study.

Objectives: To determine the prevalence of cardiovascular disease (CVD) risk factors and explore associations with high-sensitivity cardiac troponin I (hscTnI) and high-sensitivity C-reactive protein (hsCRP) in people living with HIV (PLHIV) in Kenya.

Design: Pilot cross-sectional study.

Setting: Data were collected from community HIV clinics across two sites in Nairobi, Kenya, from July 2019 to May 2020.

Treatment and outcomes in patients with left ventricular thrombus - experiences from the Aga Khan University Hospital, Nairobi - Kenya.

Introduction: left ventricular thrombus (LVT) may lead to thromboembolism and has been associated with increased morbidity and mortality. Little is known about the incidence, etiology and outcomes in patients with LVT in Africa. The objective was to determine the etiology, treatment practices, rate of resolution and clinical outcomes in patients with LVT in the region.

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.

The inaugural meeting of the Africa Heart Rhythm Association (AFHRA).

Cardiorhythm Africa, the inaugural conference of AFHRA, was conceived during the biennial PASCAR congress held in Johannesburg in November 2019, with the ambition to be the largest ever pan-African conference focused purely on arrhythmia. Significant aims were to (1) bring together arrhythmia specialists from across Africa and from the diaspora; and (2) announce the newly formed African Heart Rhythm Association (AFHRA), an affiliate organisation of PASCAR formed from the amalgamation of the Cardiac Pacing and Arrhythmias taskforces. The meeting held in Nairobi (29-31 January 2020) was organised to provide a focus on resource-constrained arrhythmia management within the African context and novel/advanced and potentially home-grown solutions.

Resource and Infrastructure-Appropriate Management of ST-Segment Elevation Myocardial Infarction in Low- and Middle-Income Countries.

The 143 low- and middle-income countries (LMICs) of the world constitute 80% of the world's population or roughly 5.86 billion people with much variation in geography, culture, literacy, financial resources, access to health care, insurance penetration, and healthcare regulation. Unfortunately, their burden of cardiovascular disease in general and acute ST-segment-elevation myocardial infarction (STEMI) in particular is increasing at an unprecedented rate.

Long-Term Outcomes and Factors Associated with Mortality in Patients with Moderate to Severe Pulmonary Hypertension in Kenya.

Background: Pulmonary hypertension is poorly studied in Africa. The long-term survival rates and prognostic factors associated with mortality in patients with moderate to severe pulmonary hypertension (PH) in Africa are not well described.

Objectives: To determine the causes of moderate to severe PH in patients seen in contemporary hospital settings, determine the patients' one-year survival and the factors associated with mortality following standard care.

Outcomes in patients with acute coronary syndrome in a referral hospital in sub-Saharan Africa.

Background: Coronary artery disease and its acute presentation are being increasingly recognised and treated in sub-Saharan Africa. It is just over a decade since the introduction of interventional cardiology for coronary artery disease in Kenya. Local and regional data, and indeed data from sub-Saharan Africa on long-term outcomes of acute coronary syndromes (ACS) are lacking.

Statistics on the use of cardiac electronic devices and interventional electrophysiological procedures in Africa from 2011 to 2016: report of the Pan African Society of Cardiology (PASCAR) Cardiac Arrhythmias and Pacing Task Forces.

Aims: To provide comprehensive information on the access and use of cardiac implantable electronic devices (CIED) and catheter ablation procedures in Africa.

Methods And Results: The Pan-African Society of Cardiology (PASCAR) collected data on invasive management of cardiac arrhythmias from 2011 to 2016 from 31 African countries. A specific template was completed by physicians, and additional information obtained from industry.

Regional fractionation and dominant frequency in persistent atrial fibrillation: effects of left atrial ablation and evidence of spatial relationship.

Aims: The aim was to study regional fractionation and dominant frequency (DF) to determine if any relationship exists between the two parameters and also to assess the impact of limited left atrial ablation.

Methods And Results: Patients undergoing catheter ablation of persistent AF using three-dimensional navigation were studied. Regional left atrial electrograms were analysed in the frequency domain by assessing DF and organization index (OI), and for degree of fractionation [using complex fractionated electrograms (CFE)-mean] before and after circumferential pulmonary vein and left atrial roof ablation.

Comparison of complete versus incomplete stent frame expansion after transcatheter aortic valve implantation with Medtronic CoreValve bioprosthesis.

We sought to determine the significance of incomplete stent frame expansion after transcatheter aortic valve implantation with the Medtronic-CoreValve device. Incomplete coronary stent expansion is a well-described phenomenon. Transcatheter valves are mounted on stents; however, the incidence of incomplete stent expansion after transcatheter aortic valve implantation, its sequelae and predictors are poorly elucidated.

Ganglionic plexus ablation during pulmonary vein isolation--predisposing to ventricular arrhythmias?

Catheter ablation is increasingly used to treat patients with atrial fibrillation (AF). Ablation of ganglionic plexi is often performed to reduce vagal innervation and has been shown to confer a better long-term outcome in terms of AF recurrence. We report a case of a patient having AF ablation with a profound vagal response, suggesting ganglionic plexus ablation, who subsequently developed ventricular fibrillation after programmed ventricular stimulation.

Prosthesis-patient mismatch after transcatheter aortic valve implantation with the Medtronic-Corevalve bioprosthesis.

Aims: Prosthesis-patient mismatch (P-PM) is an important determinant of morbidity and mortality following open aortic valve replacement. The aims of this study were to report its incidence and determinants following transcatheter aortic valve implantation (TAVI) with the Corevalve bioprosthesis, which have-thus far-not been described.

Methods And Results: Patients with severe calcific aortic stenosis received TAVI with the Corevalve bioprosthesis via transfemoral route.

Increase in organization index predicts atrial fibrillation termination with flecainide post-ablation: spectral analysis of intracardiac electrograms.

Aims: The mechanism of the action of flecainide in the termination of human atrial fibrillation (AF) is not fully understood. We studied the acute effects of flecainide on AF electrograms in the time and frequency domain to identify factors associated with AF termination.

Methods And Results: Patients who were still in AF at the end of catheter ablation for AF were given intravenous flecainide.