Prevalence and determinants of cardiac arrhythmias and conduction anomalies in

adults aged ≥ 40 years in Jimma Town, Southwest of Ethiopia: a cross-sectional study

Iyasu Tadesse Bukata1, Elsa Tegene2, Teshome Gobena3, Yohannes Markos Woldesenbet4

1. Lecturer of medical physiology, Department of Medical Physiology, Faculty of medical sciences, Institute
of Health, Jimma University, Jimma, Ethiopia: email: [email protected], phone: +251912492329;
P.O.Box: 378, Jimma, Ethiopia.
2. Assistant professor of internal medicine, Department of internal medicine, Faculty of medical sciences,
Institute of Health, Jimma University, Jimma, Ethiopia: email: [email protected], phone:
+251911769176; P.O.Box: 378, Jimma, Ethiopia.
3. Assistant professor of medical physiology, Department of Medical Physiology, Faculty of medical
sciences, Institute of Health, Jimma University, Jimma, Ethiopia: [email protected],
phone: +251911487658; P.O.Box: 378, Jimma, Ethiopia.
4. Lecturer of medical physiology, School of Medicine, College of Medicine and Health Sciences, Wolaita
Sodo University, Wolaita Sodo, Ethiopia: email: [email protected], phone: +251911016539;
P.O.Box: 138, Wolaita Sodo, Ethiopia.

Abstract
Background: The prevalence of cardiac arrhythmia (CA) in the Ethiopian population is unknown. A community study was
conducted to assess the magnitude and predictors of CAs in adults aged≥40 years in Jimma Town.
Methods: A community-based cross-sectional study was conducted in Jimma town from May to July 2017. A total of 634
adults aged 40 years or older were selected using a systematic sampling technique from six kebeles of the Town. Study par-
ticipants were screened for CA using a 12-lead ECG machine. Face-to-face interviews, anthropometric, important clinical
measurements were performed. Data analysis was done using SPSS for windows version 21.0.
Results: A total of 634 study participants, significant CA occurred in 217 individuals (34.2%). Conduction abnormalities
and sinus bradycardia were the commonest findings (25.4%). Premature beats (ventricular 1.9%, atrial 1.1%) and atrio-
ventricular nodal reentrant tachycardia (2.1%) were the next most frequent arrhythmias. Arrhythmias were independent-
ly associated with smoking(AOR=1.9;P=.047), hypertension(AOR=1.5;P=.02), heart failure(AOR=2.06;P=.023), prior
stroke(AOR=4.9;P=.001), previous history of MI(AOR=1.78;P=.039), vigorous intensity activities(AOR=0.56;P=.024),
solidified vegetable oil consumption(AOR=3.5;P=.004), and occupation(pensioner, none)[AOR=1.7;P=.017].
Conclusion: CA is highly prevalent in Jimma. Hypertension and history of heart diseases are the most potent predictors of
cardiac arrhythmia. Large-scale screening for early detection of arrhythmia has important implications for treatment.
Keywords: Cardiac arrhythmia; prevalence; risk-factors; 12-lead ECG; Jimma Town.
DOI: https://dx.doi.org/10.4314/ahs.v22i1.27
Cite as: Bukata IT, Tegene E, Gobena T, Woldesenbet YM. Prevalence and determinants of cardiac arrhythmias and conduction anomalies in
adults aged ≥ 40 years in Jimma Town, Southwest of Ethiopia: a cross-sectional study. Afri Health Sci. 2022;22(1):210-9. https://dx.doi.
org/10.4314/ahs.v22i1.27
Background worldwide1 and cardiovascular diseases (CVDs) are the
Chronic non-communicable diseases (CNCDs) have number one cause of mortality worldwide and places a
become the leading causes of death and disability high medical and socioeconomic burden on develop-
ing countries. Rapid urbanization and the demographic
Corresponding author: shift play a great role in the burden of the disease in
Iyasu Tadesse Bukata. these worlds2.
Lecturer of medical physiology, About half of all cardiac death cases are attributable
Department of Medical Physiology, to sudden cardiac death, defined as natural death from
Faculty of medical sciences, cardiac causes, heralded by abrupt loss of conscious-
Institute of Health, Jimma University, ness within 1 hour of the onset of an acute change in
Jimma, Ethiopia: P.O.box: 378, Jimma Ethiopia; cardiovascular status with, or without preexisting heart
Phone: +251912492329 disease3. Among the causes of sudden cardiac deaths,
Email: [email protected] cardiac arrhythmias (CA) confer a substantial risk of
African © 2022 Bukata IT et al. Licensee African Health Sciences. This is an Open Access article distributed under the terms of the Creative commons Attribution License
Health Sciences (https://creativecommons.org/licenses/BY/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.
210 African Health Sciences, Vol 22 Issue 1, March, 2022
mortality and morbidity and this represents a major Vasculature. The current work is the continuation of
health care burden worldwide4. that work Elsah Tegene et al25 and we used the same
methodology for both of these studies.
Recent years have witnessed important advances in our
understanding of the electrophysiologic mechanisms Materials and Methods
underlying the development of CA. They are generally Study Setting, Design, and Sampling
divided into 2 major categories: 1. enhanced or abnor- A community-based cross-sectional study was conduct-
mal impulse formation (ie, focal activity) and 2. conduc- ed in Jimma town, Southwest Ethiopia. We followed
tion disturbances (ie, reentry)5, 6,7. Also, one study says the methods of Elsah Tegene et al 201925. Jimma city
that irregular cardiac rhythmic patterns are caused by consists of 17 kebeles (the lowest administrative unit) in
abnormal initiation or propagation of electrical excita- which more than 600,000 people dwell. The study was
tion signals within the heart and leads to cardiac arrest8. conducted from May to July 2017.
There are various types of CA, including atrial fibril- Residents of Jimma town whose age is ≥40 years were
lation, conduction disorders, bradycardia, premature included in the study. The sample size was determined
contraction, tachycardia, and ventricular fibrillation or using single population proportion formula. A P val-
fluttering9. ue of 0.5, the margin of error 0.05, a design effect of
1.5and a non-response rate of 10% were considered.
Studies confirm that primary prevention and early in- After, extrapolated from world health organization
tervention on the potential risk factors of cardiovascu- (WHO) estimates for risk factor assessment studies, we
lar diseases including asymptomatic CAs in the general got a sample size of 634.
community is helpful to lessen the morbidity and mor-
tality that will result10. For this reason, it would be useful Patients were sampled by the multistage sampling tech-
to have reliable data on the prevalence and associated nique. First, six Kebeles were selected from the seven-
factors of CA in asymptomatic participants in the gen- teen Kebeles of the town by simple random sampling,
eral population. Despite this, community-based data then the sample size was distributed to the six Kebeles
on the prevalence of cardiac arrhythmias in developing employing proportional to size allocation to the Kebe-
countries like Ethiopia are scarce. les. The households from the kebeles were selected by
The prevalence of CA in the community is very high. the systematic sampling technique. The lottery method
A study from Hong Kong found a 14.9% prevalence11 was used to sample an individual from the household
whereas a study conducted by Gogolashvili et al. found when two or more adults aged 40 and above were found
a 16.8% prevalence among the rural population of in the household.
Krasnoyarsk Territory12. A cross-sectional study con- Jimma University Institutional Review Board approved
ducted among heavy vehicle drivers found a prevalence the study. Informed consent was obtained from all par-
of 59.1 %13. ticipants.
On the contrary, a study conducted in Ontario, Cana-
da, among chiropractic patients found 26% premature Data Collection and measurements
ventricular contractions (PVCs), 9.6% premature atrial Medical history of the patients
contractions (PACs), 6.4% had atrial fibrillation (AF), Demographic information; past and current smoking
3.2% had missed beats and 3.2% had a bundle branch and drinking habits; history of hypertension; coronary
block14. heart disease; diabetes mellitus and stroke; the preva-
lence of these diseases in first-degree relatives; use of
Although the prevalence of CA increases with age, sev- medications and dietary habits were collected using the
eral lines of evidence suggest that sex, tobacco smoking, questionnaire.
khat chewing, diabetes, obesity, hypertension, obstruc-
tive sleep apnea, congestive heart failure, and stroke Anthropometric measurement
have been reported to cause cardiac arrhythmia15-24. Yet, Height was measured using a stadiometer installed with
the prevalence and predictors of CA in the adult Jimma a weight scale and weight was recorded after measuring
community are not known. the participants barefoot to the nearest 0.1 kg using a
We recently studied the magnitude and predictors of weight balance (TANITA 380, Tokyo, Japan). Partici-
atrial fibrillation in adults aged 40 and above in Jim- pants faced away from the wall with the heels together
ma town, Southwest Ethiopia, and made the findings and the back as straight as possible. The head, shoul-
available for the scientific community in IJC Heart and ders, buttocks, and heels touched the vertical stand. The
African Health Sciences, Vol 22 Issue 1, March, 2022 211
participant steps away from the wall and the height cardiogram result was printed. Abnormal ECG find-
measurement is recorded to the nearest 0.1 cm. Body ings were classified according to the Minnesota Code
mass index was calculated from height and weight Classification System: Arrhythmias were classified as
measurement. premature atrial, nodal, or ventricular beats (code 8.1),
Waist circumference was measured in accordance with ventricular tachycardia (code 8.2), atrial fibrillation or
the guideline of the International Diabetic Federation26 flutter (code 8.3), supraventricular tachycardia (code
and we used the European cut-off to interpret the waist 8.4), first-degree heart block (code 6.3), left bundle
circumference measurements for the sub-Saharan Afri- branch block (code 7.1), and right bundle branch block
can. (code 7.2) 28.

Blood pressure measurement Statistical analysis

Blood pressure (BP) was measured all three times in the Data were entered into EPI data manager version
left arm with a digital sphygmomanometer (NUTEC, 4.0.2(The EpiData Association, Odense, Denmark) and
BP09, CDC). Three seated BP measurements were tak- exported to SPSS V 21 (SPSS, Chicago, IL, USA) for
en for each subject spaced five minutes apart. The BP analysis. Frequency distributions were first explored by
was taken using a mercuric sphygmomanometer from cross-tabulations by arrhythmia and were expressed in
the left upper arm after the participant was seated qui- percentage (%). Continuous variables were expressed
etly for at least 5 min (average of three measurements). as mean ± standard deviation values. Binary and mul-
BP was measured using a standard adult arm cuff of tivariable logistic analyses were applied to assess pre-
aneroid type and a digital sphygmomanometer after 5 dictors of CA. Normality of continuous variables was
min rest. Three readings were taken with 5 min intervals checked using graphic methods (Histograms with nor-
and the average of the three readings was recorded as mality curves and QQ-plots) and multicollinearity was
the final BP of the patient27. checked and Hosmer Lemeshow test was done for as-
sessing goodness of model fitness. A p-value ≤ was
Electrocardiographic examination considered for statistical significance.
A resting 12-lead body surface portable Electrocardi-
ogram(ECG1200G, YSIP-155, Beijing, China) was re- Results
corded using regularity of 1 mV = 10 mm and a paper Socio-demographic characteristics of the partici-
speed of 25 mm/sec and then reviewed by a cardiolo- pants
gist. Electrocardiogram (ECG) electrode explores elec- A total of 634 participants took part in this study out
trical impulse generated through the extracellular fluid; of whom 360 (56.8%) were females while 274 (43.2%)
we first have participants lie supine on examination bed were males.
calmly and then clean the subsequent anatomical loca- The mean age of the participants was 63.3±11.9 years.
tion for each electrode with alcohol, cut if non-conduc- And the majority of study participants were in the age
tive tissue such as hair(in male participants) were there group of sixty to sixty-nine (60-69).
and then applied cardio- cream to enhance conductivi- Around 257(40.5%) were illiterate, 231(36.4%) com-
ty; electrodes were placed accordingly and participants pleted primary level education (1-8), whereas a total
asked to close his/her eyes to avoid disturbances and of 98(15.5%) completed secondary level education but
eventually after clear waveform recruited the electro- only 48(7.6%) had tertiary level education (Table 1).

212 African Health Sciences, Vol 22 Issue 1, March, 2022

 Table 1: Distributions of socio-demographic baseline of study participants by arrhythmia status,
Jimma Town, May- July, 2017.

N(%) %
Variables Categories Arrhythmia status differen P-value
ce
Yes (%) No (%)
Sex Female 360(56.8) 109(30.3) 251(69.7) 0 0.016
Male 274 (43.2) 108(39.4) 166(60.6) 9.1%

Age 40-49 78(12.3) 20(25.6) 58(74.4) 0 0.001

50-59 133(21.0) 34(25.6) 99(74.4) 0
60-69 199(31.4) 66(33.2) 133(66.8) 7.6%
70-79 166(26.2) 67(40.4) 99(59.6) 14.8%
80+ 58(9.1) 30(51.7) 28(48.3) 26.1%
Ethnic Group Oromo 295(46.5) 99(33.6) 196(66.4) 2.8% 0.53
Amhara 108(17.0) 35(32.4) 73(67.6) 1.6%
Others* 231(36.4) 83() 148() 13.3%

Religion Orthodox 120(36.7) 207(63.3) 5.8%

0.47

Protestant 10(35.7) 18(64.3) 4.8%

Muslim 84(30.9) 188(69.1) 0
°Others 3(42.9) 4(57.1) 12%
Income Low income 170(32.8) 348(67.2) 0
0.137
High income 22(43.1) 29(56.9) 10.3%
Marital Status Married 119(33.9) 232(66.1) 0.6%

0.943
Widowed/wer 72(35.1) 133(64.9) 1.8%
**Others 26(33.3) 52(66.7) 0
Occupation Employee 63(29.7) 149(70.3) 3.3% 0.000
House wife 55(26.4) 153(73.6) 0
^Others 99(46.3) 115(53.7) 19.9%
Educational Illiterate 83(32.3) 174(67.7) 0 0.468
Status Primary 81(35.1) 150(64.9) 2.8%
2ndaryEduc. 32(32.7) 66(67.3) 0.4%
Diploma + 21(43.8) 27(56.3) 11.5%
*Wolayta, Kafa, Dawuro, Gurage, Silte, Yem etc. °Catholic, J. witness, Waqefata;**single/unmarried, separated, Divorced;
^None,Pensioners.

Prevalence of cardiac arrhythmia al fibrillation was seen in 27(4.3%) individuals. First-de-

The prevalence of arrhythmias was 217 (34.2%). Left gree, second-degree, and third-degree atrioventricular
bundle branch block found in 50(7.9%) but right bun- blocks were seen in 1.6, 0.6, and 0.2, respectively (See
dle branch block found in 35 (5.5%) individuals. Sinus Table 2 below). Arrhythmia prevalence increased with
bradycardia was found in 48(7.6%) whereas sinus tachy- age. Those whose age eighty and above were 26.1%
cardia was seen in 32 (5.0%) of study participants. Atri- more prone to develop arrhythmia than those who were
in their forties (Fig 1).

African Health Sciences, Vol 22 Issue 1, March, 2022 213

Socio-demographic and lifestyle risk factors of Ar- .929], P=.024) than those whose work doesn’t involve
rhythmia vigorous-intensity activities.
In multivariate analysis study participants who were Study participants who were hypertensive were 1.5
smokers during the study, time was nearly 2 times times more likely to develop arrhythmia than those
more likely to experience arrhythmias than those who who were non-hypertensives (AOR= 1.56; [95%C.I:
were not smokers (AOR=1.95; [95%C.I: 1.008, 3.760]; 1.047, 2.336]; P= .029). Study participants who had a
P=.047). Study participants who consumed solidified history of MI were nearly 2 times more likely to have
vegetable oil was more than 3 times more likely to have CA than those do not have MI (AOR=1.78;[95%C.I:
arrhythmia than compared with non-consumption of 1.029, 3.091], p=.039). Similarly, individuals who had
solidified vegetable oil (AOR=3.50;[95%C.I: 1.502, congestive heart failure were 2.065 times more like-
8.175];P=.004). ly to develop arrhythmia than those who do not have
congestive heart failure (AOR=2.07;[95%C.I: 1.103,
Study participants who were retired, and who do not 3.867];P=.023). In addition to this, participants who
have a job (whose occupations were none) were 1.7 had a history of stroke were five times to have arrhyth-
times more likely to have arrhythmia than employees mia than those who did not have a history of stroke
(AOR= 1.78; [95%C.I: 1.108, 2.857]; p=.017). It was (AOR=4.98; [95%C.I: 1.921, 12.929]; P=.001). Partici-
also observed that individuals who were involved in vig- pants were screened for obstructive sleep apnea (OSA)
orous-intensity activities were protected by half from risk using the STOP questionnaire and accordingly,
developing arrhythmias (AOR=.57; [95%C.I: .343, 311(49.1%) were low risk for OSA, and 323(50.9%)
were high risk for OSA (See table 3 and Fig 2).

Table 2: Prevalence of types of cardiac arrhythmias from ECG findings, Jimma town,
May to July, 2017.

Cardiac Arrhythmias Frequency(n) Percent (%)

Conduction disturbances
Sinus bradycardia 48 7.6
1rst degree AVB 7 1.1
2nd degree AVB 4 0.6
3rd degree AVB 1 0.2
Complete LBBB 50 7.9
Incomplete LBBB 11 1.7
Complete RBBB 35 5.5
Incomplete RBBB 5 0.8
Sinus tachycardia 32 5.0
Sinus arrhythmia 6 0.9
Atrial flutter 3 0.5
Atrial fibrillation 27 4.3
PACs 7 1.1
SVT(AVNRT) 13 2.1
Wolf Parkinson White 4 0.6
Idioventricular rhythm 2 0.3
Ventricular tachycardia 2 0.3
PVCs 12 1.9
PACs, premature atrial contractions; SVT, supraventricular tachycardia; PVCs, premature
ventricular complexes; AVB (atrioventricular block), LBBB & RBBB (left and right bundle branch block)

214 African Health Sciences, Vol 22 Issue 1, March, 2022

 Table 3:- Multivariable logistic regression model predicting cardiac arrhythmias
among study participants in Jimma Town from May to July 2017.

Models β P AOR 95% CI

Lower Upper
Sex
Male .173 .468 1.188 .745 1.895
Female 1.000
Age group(yrs)
40-49 1.000
50-59 -.253 .467 .776 .393 1.535
60-69 .021 .949 1.022 .534 1.954
70-79 .134 .698 1.144 .579 2.259
80+ .366 .383 1.443 .633 3.287
Occupation
Employee 1.000
Housewife -.157 .586 .854 .485 1.505
Others(pensions, none) .576 .017 1.779 1.108 2.857
Vigorous Physical Activity
Yes -.571 .024 .565 .343 .929
No 1.000
History of myocardial
infarction
Yes .579 .039 1.784 1.029 3.091
No 1.000
Obstructive sleep apnea
High risk .272 .148 1.312 .908 1.895
Low risk 1.000
Currently smoking
Yes .666 .047 1.947 1.008 3.760
No 1.000
Congestive Heart Failure
Yes .725 .023 2.065 1.103 3.867
No 1.000
History of Stroke
Yes 1.606 .001 4.983 1.921 12.929
No 1.000
Solidified vegetable oil
consumption
Yes 1.254 .004 3.504 1.502 8.175
No 1.000
Hypertension
Yes .447 .029 1.564 1.047 2.336
No 1.000
AOR=adjusted odds ratio; CI= confidence interval
(Hosmer Lemeshaw Test (P=0.982), Maximum Standard error=0.486)

Discussion its associated factors in ambulant adult study partici-

Eighty percent of the global burden CVDs occur in pants of an urban Jimma community were examined.
low and middle-income countries(LMICs) and this high The result demonstrated that the prevalence of CA was
percentage is partly due to the much larger population 34.2%. In the literature, the reported incidence of ar-
in these countries, progress in avoidance of deaths from rhythmia in the community ranges from 14.9% to 59.1
childhood diseases so that now more individuals live to %11-13. The explanation for this wide range includes
older ages when they are at risk of developing CVDs. the difference in characteristics of the population, the
In addition to this increased tobacco use, decreased sample studied (e.g. age, lifestyle, type of screening tool
physical activities, increased use of animal products, used to detect arrhythmia), or study design employed.
and increased obesity with resultant elevations in blood In contrary to our study, a study conducted in Ontar-
pressure, cholesterol, and diabetes especially in the io, Canada found a prevalence of around 20% which
countries that are responsible for the burden29. is lower than the prevalence of the current study. The
observed cardiac rhythm irregularities in this study took
The best way to reduce the burden of CNCDs; espe- various forms: 8 ECGs displayed premature ventricu-
cially cardiovascular diseases, such as cardiac arrhyth- lar contraction, 3 had a premature atrial contraction, 2
mias, is early screening and taking preventive measures. had atrial fibrillation, 1 had missed beats and 1 had a
In our study, the prevalence of cardiac arrhythmias and bundle branch block which is different from the types

African Health Sciences, Vol 22 Issue 1, March, 2022 215

of arrhythmias we found14. The possible reason for the tion of the myocardium. The conduction system of the
differences in the prevalence of cardiac arrhythmias be- heart is also affected by the latter, producing changes
tween the above study and our study might be the dif- that may result in conduction disorders or arrhythmia30.
ferences in the study design, sampling technique, sam-
ple size, and the screening tool (2-lead ECG) they used In the current study, atrial fibrillation was detected in
whose sensitivity and specificity was unknown which twenty-seven participants who account for 4.3%. This
could not identify ‘true positives’ and ‘true negatives. result is comparable or in line with an institution and
A study conducted by Özdemir et al.2012 among heavy population-based study in some African countries 4.6%
vehicle drivers found a prevalence of 59.1% which is South Africa, 5.5% Ivory Coast, 5.4% Senegal, and
far more frequent than the prevalence that is found in more than study 0.7% Kenyan tertiary referral hospi-
the current study13. The discrepancy in the results might tal(those patients might have taken medication for un-
be due to the study period, and the characteristics of derlying cause), 0.7% in Tanzanian elderly(≥70yrs)31. In
sampled participants enrolled in the study that heavy a study done in India on the prevalence of AF, they
vehicle drivers spent much of their time driving sitting have found 5.1%; however, when compared with the
thus prone to a sedentary lifestyle which could accu- current study it is different since they used a screening
mulate their risk of obesity. The detailed mechanisms tool (Alivecor) whose sensitivity and specificity was un-
linking obesity and arrhythmia are complex and are in- known and their sample size is lower than the current
dicated in the work of Yusuf S. et al29. study32. In a cohort study done in Malaysia, the preva-
lence of atrial fibrillation was found to be 0.54% which
In the present study, the most common type of arrhyth- is lower than the current study the difference could be
mia detected as conduction disturbances (sinus brad- due to the study design and study period44.
ycardia 7.6%, first-degree atrioventricular block 1.1%, The current study is also inconsistent with a study done
second-degree atrioventricular block 0.6%, third-de- on the prevalence of atrial fibrillation in Gonder teach-
gree atrioventricular block 0.2%, complete left bun- ing hospital which was 28.7% 33. The reason for the
dle branch block 7.9%, incomplete left bundle branch discrepancy might be due to that the latter study was
block 1.7%, complete right bundle branch block 5.5%, conducted among known stroke patients who were ad-
incomplete right bundle branch block 0.8%; which ac- mitted in the hospital; not in the community.
count a total of 25.4%). More importantly, atrial fibril- The present study showed that CA varied with the occu-
lation is the most frequently sustained arrhythmia with pational status of the participants with a higher propor-
a prevalence of 4.3%. tion in pensioners and those who are jobless, which is in
line with the study findings by Rodrigo J. et al34 in which
This finding is consistent with a finding reported from case they found that patients with premature complexes
a study conducted in the Chinese, Hong Kong commu- were generally older and more likely to be retired. Also,
nity11. The current study was also in the same line with progressive increment in arrhythmia prevalence with
the study conducted on pre-hospital refer cases for syn- age was noticed (it was 51.7% in those aged ≥80 years)
cope where ECG findings were; in 13% ECG showed and sex difference was observed when cross-tabulated
sinus tachycardia, in 9% sinus bradycardia. Prevalence by arrhythmia and occupation with male predominance.
of ventricular tachycardia was 0.20%, while significant A similar study reported that men were found to have
AV-disturbances were present in 1.12% of cases (0.11% a 1.5-fold higher risk of developing an arrhythmia (AF)
second-degree type 2 atrioventricular block, 0.11% ad- compared with women35.
vanced atrioventricular block, 0.19% third-degree atri- Similarly, our study found that alcohol consumption has
oventricular block, 0.45% junctional rhythm, 0.26% no significant association (P=0.947) with arrhythmia. In
ventricular rhythm(30). According to Brunetti ND et agreement with the current study, one study concluded
al aging affects the cardiovascular system in multiple that low levels of alcohol intake are not associated with
ways, including a decrease in compliance of blood ves- the development of AF. In contrast to this study done
sels through arterial stiffening and thickening, mild left in Germany confirmed there exists an association be-
ventricular thickening, and a shift in the balance of early tween sinus tachycardia and chronic alcohol consump-
versus late diastolic filling. Many of these changes result, tion and atrial fibrillation in holiday heart syndrome36.
in part, from cardiac cell enlargement with apoptosis The possible deviation in our study might be most of
of neighboring cells and subsequent fibrofatty infiltra- the study participants consume local liquors such as tel-

216 African Health Sciences, Vol 22 Issue 1, March, 2022

la, tej, etc of which alcoholic content may be less than congestive heart failure, and prior stroke. However,
standard alcohol. the most potent predictor was a prior ischemic attack
In our study smokers were nearly 2 times more likely (stroke). Future research should look into further on
to have arrhythmia than non-smokers. Alanna M. et al. the overall burden of CA using the Holter ECG moni-
also reported that smoking was associated with the inci- tor on a large-scale population.
dence of arrhythmia, with more than a 2-fold increased
risk of AF attributed to current smoking37, 38. Abbreviations
In addition, the present study showed that khat chewing BMI: Body Mass Index CA: Cardiac Arrhythmia
has no significant association with CA (p=0.652). In an CVDs: Cardiovascular Diseases ECG/EKG: Electro-
argument with our study findings, a study conducted in cardiogram
Yemen in 2016 found that the prevalence of non-sus- LMICs: Low-and-Middle Income Countries
tained ventricular tachycardia was higher among khat NCDs: Non-communicable Diseases
chewers39. The possible difference is that majority of WHO: World Health Organization
the participants in our study were women (who do not
culturally encourage to chew khat than men). Declarations
Ethics approval and consent to participate.
According to the present study, participants who were
hypertensive are 1.5 times more likely to have arrhyth- The study was approved by the Institutional Review
mia than non-hypertensives. A similar study was done Board of Jimma University. Confidentiality and written
in Malaysia also found an association between CA and consent was sought from all the study participants.
hypertension40. Other researchers reported a 3.46%
prevalence in hypertensives, indicating hypertension as Consent for publication
an independent predictor for commonest sustained ar- Not Applicable.
rhythmia41. Hypertension has two major consequences
on the heart: left ventricular hypertrophy, and morpho- Availability of data and material
logical and functional alterations of the coronary mac- Data can be accessed from the corresponding author.
ro- and micro-vessels. These two cardiac modifications
then cause 3 types of complications: myocardial is- Competing interests
chemia left ventricular dysfunction and electrical insta- The authors declare that they have no competing inter-
bility, which are implicated in the pathogenesis of atrial ests.
and ventricular arrhythmias in hypertensive patients42.
The primary strength of the study is the use of hospital Funding
standard 12-leads ECG in a relatively sizeable sample in This project was funded by Jimma University.
the general population and early screening of life-threat-
ening arrhythmia to tackle morbidity and mortality that Authors' contributions
will ensue. However, it is likely that some participants ET analyzed and interpreted the patient data regarding
with paroxysmal AF may have been missed. So, one of the ECG. IT performed the electrocardiographic exam-
the limitations of the current study is our inability of ination. IT and YM developed the manuscript. IT, YM,
using the Holter monitor ECG. In addition, we didn’t and TG edited the manuscript. All authors read and ap-
examine the echocardiography recordings and so we proved the final manuscript.
were unable to see structural and dimensional views of
the heart. Acknowledgments
Not Applicable.
Conclusion
The prevalence of CA in the current population is References
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