THE 1995 SURVEY OF CARDIAC PACING IN SOUTH-AFRICA

A survey of implanters of permanent cardiac pacemakers during 1995 was conducted to determine pacemaker implantation rates and identify pres ent and changing patterns in pacing practice in South Africa. The five major pacemaker manufacturers/distributors provided estimates of the numbers of implanters, implanting institutions, and pacemakers implant ed in South Africa in 1995. In 1995, pacemaker implantations were perf ormed by 75 doctors working in 30 hospitals. Since the last survey, wh ich addressed pacing practices in 1986, the primary permanent pacemake r implantation rate increased from 16 to 31 devices per million popula tion per year. There were, however, very large disparities in implant rates between Asians (219/million/year), whites (150/million/year), co loureds (16/million/year) and blacks (7/million/year). Over this perio d the number of implanting centres doubled, although more than half (5 3%) were located in one province. Atrioventricular block remains the m ain indication for permanent pacing (63% of implants), sinus node diso rders accounted for 28%,bundle-branch block for 4%, atrioventricular n ode ablation for tachyarrhythmias for 3%, cardiomyopathy for 1%, and o ther causes for 1%. Single-chamber units were implanted in 62% of pati ents, dual-chamber units in 22.5%, and single-pass atrioventricular le ads (VDD) in 15%. Twenty-four per cent of single-chamber devices had r ate modulation, and 83% of dual-chamber pacemakers had rate-adaptive f eatures. Bipolar electrodes were used in 82% of atrial and ventricular leads; 55% used only bipolar leads, and only 10% used unipolar leads exclusively. The subclavian introducer technique was used in 80% of le ad insertions. Major complications were reported in less than 1% of im plants, and no deaths were documented peri-operatively. The survey has highlighted the changing trends in pacemaker use, the low pacemaker i mplantation rate, particularly in blacks, and the centralised nature o f pacing in the country. While the situation has improved over the yea rs, access to treatment of proven benefit remains poor.:Furthermore, i t is proposed that the process of pacemaker audit would be greatly sim plified by the adoption olf a prospective registry such as that used i n Europe.