Managing Wolf-Parkinson White syndrome and asymptomatic pre-excitation in Africa: a multicenter pan African registry from 17 countries

Abstract

Background Data are scarce regarding WPW syndrome and asymptomatic pre-excitation in Africa. Objectives This study aimed to understand how accessory pathways related arrhythmias are managed in Africa. Methods This prospective study was conducted in 20 centers from 17 African countries. All the included participants had ventricular pre-excitation patterns. The data collected included symptoms, locations of accessory pathways (AP) and tachyarrhythmia, risk stratification, as well as acute and long-term management. In addition, we assessed the clinical effectiveness and the impact of socio-economic and health metrics on this treatment approach. Results Of 541 participants, 93% were diagnosed with WPW syndrome, and orthodromic atrioventricular reciprocating tachycardia (AVRT) was the most prevalent arrhythmia, affecting 55% of the cases. Approximately 30% of patients, excluding the southern region, received Intravenous Amiodarone as the first-choice drug for orthodromic AVRT while Adenosine was the drug of choice in Southern region. Electrical cardioversion was the first-line treatment for pre-excited atrial fibrillation and antidromic AVRT across all of Africa. Radiofrequency ablation was the first long-term therapy option for 88 % of patients in all African regions, except in western and central Africa, where it was implemented for less than 30% of patients (P<0.001). The rates of success, long-term recurrence, and complication were 93%, 4.1%, and 3.8%, respectively. Conclusion Significant differences and challenges in the diagnosis and management strategies among countries are reported across Africa. While several countries fell short of ideal or expected health expenditures, ablation techniques are rising with success rates comparable to those in the developed world.