Permanent Pacemaker Implantation in Southern Morocco: Clinical Characteristics, Implantation Practices, and Outcomes from A Four-Year Single-Centre Study

Introduction: Permanent cardiac pacing is an established treatment for symptomatic bradyarrhythmias and clinically significant conduction disorders, but contemporary data from southern Morocco remain scarce. This study describes the clinical profile, pacing indications, implantation practices, and short- and mid-term outcomes of patients undergoing permanent pacemaker implantation at a tertiary military hospital in Agadir, Morocco. Methods: We conducted a retrospective, single-centre study of 286 consecutive patients who underwent permanent single- or dual-chamber pacemaker implantation between May 2022 and May 2026. Clinical, electrocardiographic, echocardiographic, procedural, and follow-up data were collected from medical records, pacing registries, and consultation reports. Results: Mean age was 72.9 ± 13 years, with 51.3% men, and 88.5% were symptomatic at admission. Degenerative conduction disease was the leading cause (72.34%), followed by ischemic heart disease (21.27%), and high-grade atrioventricular block was the predominant indication. Dual-chamber systems were implanted in 86.5% of cases, single-chamber in 13.5%; 66.7% were de novo implantations and 33.3% generator replacements. Twenty patients required temporary pacing. Early complications were limited to pneumothorax (1.25%), seven minor hematomas, and nine lead displacements, with no early infections. Over a median follow-up of three years, three pacemaker dysfunctions, one late pocket infection requiring extraction and reimplantation, and two cases of pectoral stimulation occurred, without deaths. Conclusion: In this southern Moroccan cohort, pacemaker implantation predominantly involved elderly patients with high-grade atrioventricular block, dual-chamber pacing was the main strategy, and outcomes were favorable. Larger multicentre studies and national pacing registries are needed to guide future practice and technology adoption.