Permanent Cardiac Pacing in Togo: Current Status, Clinical Outcomes and Perspectives in a Resource-Limited Setting

Background: Permanent cardiac pacing is the standard treatment for severe symptomatic bradyarrhythmias and conduction disorders. In low-income countries, access to pacemaker therapy remains limited, and published data are scarce. Objective: To describe the evolution of permanent pacemaker implantation in Togo, analyse patient characteristics, indications, outcomes and complications, and discuss challenges related to a resource-limited setting. Methods: A retrospective descriptive study was conducted in the main cardiology centres in Togo from January 2010 to December 2025. All patients who underwent permanent pacemaker implantation were included. Sociodemographic, clinical, electrocardiographic, technical and outcome data were analysed. Results: A total of 291 patients were included. The mean age was 70.9 ± 12.5 years, with a male predominance. Dyspnoea (58.5%) and syncope (31.3%) were the most common presenting symptoms. High-degree atrioventricular block was the leading indication for implantation. The mean delay between diagnosis and implantation was 38.3 days. Dual-chamber pacemakers accounted for 49% of all implants, with a marked increase since 2022 (81.4%). The overall complication rate was low, with each major complication occurring in less than 3% of cases. Conclusion: Permanent cardiac pacing is feasible and safe in Togo. Despite persistent delays, recent improvements reflect strengthening local expertise. Establishing a national registry and improving financial access to devices are key priorities to optimise care.