Introduction Permanent pacemaker implantation is a common procedure to manage various cardiac rhythm disorders. Understanding the prevalence and the short- and long-term outcomes associated with pacemaker implantation is crucial for optimizing patient care and improves prognosis.

Objective This study examined the clinical outcomes and complications associated with the implantation of pacemaker devices in HPUSM.

Methods This is a retrospective, single centre study conducted on 151 consecutive patients who had pacemaker implanted between 2014–2024. Sociodemographic factors, clinical characteristics, and complications data were extracted from medical record unit. The chi-square test or Fisher's exact test was performed to evaluate factors associated with complications.

Results Majority of patients were between 61–80 years (66.9%), and (62.9%) were males. Hypertension was the most common comorbidity (68.9%), followed by hyperlipidaemia (56.3%), ischemic heart disease (41.7%), and diabetes mellitus (39.7%). Complete heart block was the main indication for pacemaker implantation (55.6%), followed by sick sinus syndrome (34.4%). Dual-chamber pacemaker in DDD mode was the most commonly utilized (92.1%) and majority of RV lead were placed at RV apex (78.1%) and the rest were implanted in the alternate site. The overall complication rate was 12.5%, including lead dislodgement 4%, infection 1.3%, pneumothorax 1.3%, hematoma 0.7%, cardiomegaly 2.6%, and heart failure 2.6%. In the apical group, there were four cases of lead dislodgement, compared to two cases in the alternate site group (p= 0.391). Additionally, four patients in the apical group experienced heart failure (p= 0.369) and no case of heart failure in alternate site. One case of hematoma was reported in the apical group, and there were two cases of pacemaker infection in the same group (p= 0.610). For pneumothorax, one case was observed in each group (p=0.390).

Conclusion This study established a pacemaker implantation and follow-up service at our institution, supported by a comprehensive database. The primary indication for implantation was complete heart block. Dual chamber pacing was more commonly used. Elderly male patients with ischemic heart disease and comorbidities required more pacemaker implantations. Alternate site pacing was associated with fewer complications, including lead dislodgement, heart failure, and infection, comparable with evidenced literature, although these findings were not statistically significant.