Permanent pacemaker insertion for bradyarrhythmias in a secondary health facility in sub-Saharan Africa.

Background: Permanent cardiac pacemaker (PPM) insertion has been used clinically since 1960. It is a lifesaving procedure in symptomatic bradyarrhythmia. The experience of PPM implantation in non-Western countries has not been well characterized. Objective: This study reports our experience in pacemaker insertion in the newly remodeled District General Hospital Awa. The Akwa Ibom state government fully sponsored the procedures with state funds; otherwise, patients would have to pay out of pocket. Methods: The general hospital is fully equipped with an ultramodern theater with C-arm fluoroscopy and audiovisual facilities, and there is an anteroom in the procedural suite where people can watch for virtual learning. This is the first of its kind. Results: A single-chamber (VVIR) pacemaker was implanted in all patients. There were no acute complications postsurgery. All patients were followed for at least 3 months. There were no deaths reported at the 3-month follow-up. Device interrogations were performed at the 3-month follow-up visit, and device parameters were all stable with excellent sensing thresholds. Routine follow-up for our center is a regular 2-monthly follow-up in the first year. Conclusion: We conclude that permanent pacemakers can be safely carried out in a well-equipped district general hospital. Most needy patients are likely older, with complete heart block as the commonest indication. However, government and/or nongovernmental organizations need health insurance or subsidization to make it sustainable in low-income countries to which Nigeria belongs.