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All-cause and device-related mortality post-pacemaker implantation: a continental meta-analytic perspective
Journal article

All-cause and device-related mortality post-pacemaker implantation: a continental meta-analytic perspective

Carlson Sama, Saim Rana, Sittinun Thangjui, Abhiram Challa, Justin Conte, Sudarshan Balla, Sandeep Arora, Ayodeji Dina, Matthew Santer, Alexey Sergeev, …
Next research, Vol.11, 101983
09/2026
DOI: 10.1016/j.nexres.2026.101983

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Abstract

Access to permanent pacemaker therapy in sub-Saharan Africa is critically limited, and patient outcomes remain poorly defined. We sought to quantify all-cause and device-attributable mortality following pacemaker implantation across African healthcare settings to inform clinical practice and policy. We performed a systematic search of PubMed/MEDLINE, African Index Medicus, and African Journals Online from inception through July 19, 2025, for studies reporting post-implant mortality. We pooled logit-transformed proportions using a random-effects meta-analysis and back-transformed to percentages. Heterogeneity was assessed with Cochran’s Q and I² statistics. Twenty-three studies (n = 3,709) were included. Over a follow-up period spanning up to 387months, the pooled all-cause post-implant mortality was 4.9% (95% CI: 2.8–8.5%). Sixteen studies (n = 2080) reported two pacemaker-attributable deaths, yielding a pooled device-related mortality of 0.94% (95% CI: 0.46–1.95%). In a pooled meta-analysis of secondary outcomes, lead displacement 3.0% (95% CI: 2.1–4.3%), pocket/lead infections in 2.7% (95% CI: 1.7–4.4%), and pocket hematomas 2.1% (95% CI: 1.1–4.0%) were the most frequent complications, occurring at varying times post-implant. In the single study that evaluated predictors of mortality, male sex, higher Charlson comorbidity index, post-implant complications, and NYHA class III–IV status were identified as factors associated with higher all-cause mortality. These findings suggest that permanent pacemaker implantation in African settings is associated with a relatively low all-cause and device-related mortality; broadly comparable to global benchmarks despite resource-constraints. Strategic scale-up of pacing services, supported by targeted training programs, telemonitoring, and pan-African registries can be pivotal to expanding access and sustaining favorable outcomes across the continent.
 Africa Device safety Meta-analysis Mortality Pacemaker

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