Introduction : The atrioventricular block (AV Block) is a normal loss of function of the cardiac conduction pathway between the atrium and the ventricle. It is a serious pathology encountered throughout the world, whose management mainly involves cardiac stimulation. This study aimed to describe the practice of cardiac stimulation in Guinea. Methodology: It was a cross-sectional descriptive study lasting 22 months from November 1, 2023, to August 30, 2025. We included in the study all patients with AV block who were received at the CEMECO clinic during the study period and who benefited from the insertion of a cardiac pacemaker.

Result : We have identified 36 cases of AV Blockk out of 953 patients, 10 of whom benefited from the implantation of a pacemaker, representing an implantation rate of 27.78%. A male predominance was noted at 7/10 (70%) and the patients were aged 68 to 87 years. The symptomatology was marked by syncope 9/10 (90%) followed by exertional dyspnea 7/10 (70%). 9/10 (90%) of the cases were 3rd degree AV Blocks. The cephalic vein was the preferred route of access for 7/10 (70%) of our patients. Double chamber stimulation was the most practiced (8/10 cases, or 80%). All our patients had their clinical condition stabilized. In terms of complications, we noted a case of 1/10 (10%) of displacement of the atrial catheter, a case of 1/10 (10%) of pericardial tamponade that was well managed. 

Conclusion : The development of cardiac stimulation offers better prospects in the management of conductive disorders in our context. Measures to promote its accessibility should be considered.atrioventricular block; cardiac stimulation;  guinea

The auriculoventricular block (AV Block) refers to the existence of a disruption in the transmission of electrical impulses from the atria to the ventricles, through the atrioventricular node, the bundle of His or simultaneously in both branches of this bundle [1]. It is a serious pathology encountered throughout the world whose treatment by excellence remains cardiac stimulation [2]. The development of cardiac stimulation represents a curative treatment [3]. His practice in sub-Saharan Africa is booming with rates of first implantation increasing [2;4;5]. The practice of cardiac stimulation in Guinea was once a punctual and sporadic activity because it was reserved for health missions. However, since 2024, the installation of cardiac pacemakers has been made possible and accessible, which constitutes a major advance that revolutionizes the management of AV Blocks in our context. Thus, the present study was initiated in order to assess cardiac stimulation in Guinea.

Framework and type of study: The CEMECO clinic in Kipé served as the setting for our study. It was a cross-sectional descriptive study lasting 22 months from November 1, 2023, to August 30, 2025.  study process : This study focused on all the records of patients admitted for BAV at the clinic during the study period who had benefited from the placement of a pacemaker. We have conducted an exhaustive recruitment of all patients meeting our inclusion criteria. We included in the study all patients with a AV Block received in our department during the study period and who benefited from the installation of a cardiac pacemaker. However, we excluded from the study all patients received for AV Block during the study period but who did not benefit from a pacemaker installation. Thus, we noted the sociodemographic characteristics of the patients, then described the clinical and paraclinical data, the associated risk factors, the etiologies as well as the practical data of the implantation.

Ethics : The data were collected anonymously and used only for this study.

We have identified 36 cases of AV Block, 10 of which benefited from the implantation of a pacemaker, representing an implantation rate of 27.78%. The average age of patients at the time of cardiac stimulation was 75.4 years, with extremes of 68 and 87 years. A predominance of the male sex was noted at 7/10. The main symptom was syncope (9/10), followed by dyspnea (7/10). The 3rd degree AV Block was present in 9/10 of our patients compared to 10% of 2nd degree AV Block. Regarding the etiology, the degenerative origin was suspected in all our patients, ie 10/10. The preferred route in our patients for implantation was the cephalic vein (7/10), followed by the subclavian vein (2/10). Regarding the type of pacemaker, 9/10 of our patients had benefited from a double chamber case compared to 2/10 of a single chamber case. Furthermore, we proceeded with the placement of a temporary probe in a single patient before his recovery the next day for definitive stimulation. The ventricular lead was positioned at the apex in 8/10 patients, at the septal level in 1/10 as well as at the apex and then repositioned at the septal in 1/10 patients. The parameters at the output of the block varied between 0.5-1.5 V for the atrial threshold, 0.5-0.7 V for the ventricular threshold, between 490-630 ohms for the atrial impedance and 330-950 ohms for the ventricular impedance. The average duration of the stimulation procedure in our patients was 190 min. In terms of complications, we noted 1/10 cases of atrial probe displacement and 1/10 cases of pericardial tamponade.

In developed countries, the practice of cardiac stimulation is very advanced compared to developing countries.  In sub-Saharan Africa, more and more countries are now performing cardiac stimulation. As part of our study, we identified 36 cases of AV Block of which only 10 were implanted, representing an implantation rate of 27.78%. Our results are lower than those of Camara Y et al [2] in Mali in 2021, which had reported a primo-implantation rate of 68.3%. Moreover, our result is similar to that obtained by Baldé E et al [5] in a previous study conducted in Guinea, which had reported 14 stimulated patients out of 64 cases of AV Block collected, representing an implantation rate of 21.86%. This low rate of stimulation in our study could be explained by the fact that cardiac stimulation is recent in our context, but also the lack of patient care in a context marked by a weak development of insurance system.

In our study, the age of patients at the time of cardiac stimulation ranged from 71 to 87 years, with a mean age of 75.4 years. Our data are consistent with those found in the African literature [6, 7, 8]. In the study by Rahma K et al. [9], the average age of patients was 72 15 years. The predominance of AV Blocks at this age is explained by the degeneration of conduction pathways related to physiological aging.

In general, AV Blocks are more common among women due to their reduced mobility, unlike men who are more active. However, our sample had 70% men against 30% women. Moreover, the predominance of the female sex is often found in the literature with Tabane A et al. [10] (52%) and Tuomas K. et al. [11] (56.1%). In our study, syncope was the master symptom (9/10), followed by exertional dyspnea (7/10). This symptom remains the main manifestation encountered in African series, with prevalences ranging between 60 and 88.6%. Dyspnea was present in 67.4?cording to Camara Y et al [2]. According to Lévesque K et al [12], syncope was present in 88.6% of cases. This would probably suggest the gradual installation of conduction disorder, thus evoking the degenerative origin we had suspected. The 3rd degree BAV was present in 9/10 patients. Our result is similar to that of Camara Y et al [2] who had reported a rate of 83.7%. Ramiandrisoa L et al [1] had found 72.5% of 3rd degree BAV. From an etiological point of view, the degenerative origin was the most suspected in all our patients, i.e. 10/10. Ce résultat corrobore les données de la littérature (88.3?ns la série de  Camara Y et al.) [2]. This would be due to fibrous degeneration of the branches of the His bundle, sometimes to sclerocalciferous lesions of the trunk and the bifurcation of this bundle. The extension of indications to definitive stimulation by pacemaker or implantable automatic defibrillator is at the origin of the expansion of implantation procedures [13; 14]. From a technical point of view, the cephalic vein was the preferred route for all our patients, which is 10/10. In the study by Brignole M. et al. [14], the cephalic approach was practiced in 56.8% of cases, ahead of the subclavian (23.9%) and axillary (8%) approaches. In the study by Khadidiatou D et al. [15], the cephalic approach was mostly used in 68.3% of cases, followed by the subkeyboard approach in 31.5% of cases and the axillary approach in 0.3% of cases. This deviation from our result is explained by the scheduled nature of most procedures and the small sample of patients stimulated in our context. Regarding the type of cardiac pacemaker, 8/10 patients had benefited from a double chamber case compared to 2/10 single chamber cases. This predominance of double-chamber housing was also observed by Rahma K et al. [9] who had reported that the devices were of the single-chamber type (51.2%), double-chamber (43.2%) and triple-chamber (5.6%). However, some authors report a preference for single-chamber enclosures [6,8]. Adoubi K et al. [16] had reported the use of simple chamber ventricular pacemakers in 66.6% of cases. The preferential use of double chamber housings in our patients could be explained by its more physiological functioning and on the other hand by the predominance of AV Block 3 which constitute a preferred indication of double chamber stimulators. In our study, the ventricular probe was positioned at the apex in 8/10 patients and at the septal level in 2 patients. Furthermore, Khadidiatou D et al. [15] had reported in their study that right ventricular probes were most often implanted in the apical position (98.3%) and in the septal position in 1.7% of cases. The right ear probes were implanted on the side wall of the right atrium (88.2%) and in the right atrium pavilion (11.8%). The parameters at the output of the block ranged from 0.5 - 1.5 V for atrial threshold, 0.5 - 0.7 V for ventricular threshold, between 490 - 630 ohms for atrial impedance and 330 - 950 ohms for ventricular impedance. In the study by Yves N. et al. [17], the median detection at implantation was 3.4 mV and 6.8 mV in the atrium and right ventricle, respectively, with extremes ranging from 0.8 to 8 mV for the right atrium and 1.6 to 15 mV for the right ventricle. The median stimulation threshold was 0.85 V and 0.80 V respectively, at the atrial and right ventricular levels. The median impedances were 569 and 716 ohms respectively at the atrial and right ventricular level. The average duration of stimulation in our patients was 190 min. Our result was higher than that of Yves N. et al. [17], who reported an average duration of 90 minutes. This difference could be explained by the strong predominance of double chamber devices in our context, as well as the learning curve of the team. The short-term evolution was marked clinically by the disappearance of symptoms that led to implantation in all our patients (10/10), in agreement with the literature [6,18]. It was favorable in 95.3% of the cases in the study by Camara Y et al [2]. Infectious complications are to be avoided in the case of definitive stimulation because it is associated with an excess mortality [19; 20]. The incidence of infectious complications varies greatly according to the studies. Infectious complications accounted for 1.96% in the study by Rahma K et al. [9]. In the case of our series, we did not note any complications, notably infectious, respiratory (pneumothorax) or hemorrhage (bleeding from the surgical site). On the other hand, in terms of the device, we noted 1/10 cases of displacement of the atrial probe and 1/10 cases of pericardial tamponade, or 10%. Our results are lower than some authors such as Udo E et al [21] who had found a complication rate of 12.4%, compared to 17.4% for Millogo G et al [6]. In the study by Camara Y et al [2], complications were mainly dominated by probe displacement with 3 cases, 3 hematomas and 1 case of wound infection. This difference could be explained by the small sample size. In the study by Khadidiatou D et al. [15], complications occurred in 4.53% of patients, mainly probe displacement (1.94%), infections (1.29%), pocket hematomas (0.65%) and pneumothorax (0.65%).

The implementation rate in our series was relatively low. The cephalic vein was the preferred route for all our patients and they had mainly benefited from double chamber stimulation. The clinical course was favorable in all our patients. Furthermore, appropriate measures would make it possible to better develop this technique in our environment.