This was a retrospective, observational and descriptive study conducted in the main Togolese centres performing pacemaker implantation: Campus University Hospital, Dogta-Lafiè Hospital, Wossinu and Gbogbo Polyclinic, Bonne Espérance Clinic and Le Cœur Clinic.

All patients who underwent permanent pacemaker implantation (single- or dual-chamber) between 1st January 2010 and 30th November 2025 were included. Patients with incomplete records for essential variables were excluded from specific analyses. Patients implanted outside Togo were not included.

Data were collected from medical records, operative reports and hospital databases. Variables included age, sex, presenting symptoms, electrocardiographic indication, type of pacemaker (new or reuse), treatment delay, technical implantation data and peri- and post-operative complications.

The reconditioned pacemakers used in this study were obtained from two main sources: devices recovered outside Togo from deceased patients, within the framework of ethical and solidarity-based retrieval programs; and pacemakers retrieved locally in Togo after the death of implanted patients, with prior consent from the families. In all cases, device retrieval was conducted in accordance with ethical principles, with full traceability of the origin, model, and serial number. Devices showing visible signs of deterioration, corrosion, or malfunction were systematically excluded.

Following retrieval, pacemakers underwent careful mechanical cleaning to remove any biological or particulate residues. They were then subjected to a standardized sterilization protocol based on ethylene oxide sterilization (or another locally validated method), which is recognized for its effectiveness on heat-sensitive implantable medical devices. Each sterilization cycle was monitored using chemical and biological indicators to ensure the effectiveness of the process and the absence of residual contamination.

Before any reimplantation, a rigorous quality control process was performed. This included verification of the integrity of the device casing and connectors; assessment of battery status, with a minimum residual charge requirement sufficient to ensure an acceptable predicted device longevity; comprehensive testing of electrical parameters (output amplitude, sensitivity, impedance); and reprogramming of the device according to the patient’s clinical needs. Pacemakers that did not meet predefined safety, performance, or estimated longevity criteria were excluded from the reconditioning process.

Prior to implantation, all patients (or their legal representatives) were informed of the reconditioned nature of the device, the available therapeutic alternatives, and the potential benefits and risks. Written informed consent was systematically obtained before the procedure.

Data were analysed using R software (version 4.3) or Stata (version 17). Quantitative variables are presented as mean ± standard deviation, and qualitative variables as numbers and percentages.

The study was approved by the Ethics Committee of the Faculty of Health Sciences, University of Lomé. All data were anonymised and handled confidentially.

A total of 291 patients were included. Mean age was 70.9 ± 12.5 years (range: 44 - 104 years). There were 201 men and 90 women, yielding a male-to-female ratio of 2.23. Pacemaker implantation activity increased steadily over the study period (Figure 1).

Figure 1.Distribution of pacemaker implantations according to year.

The most frequent symptoms at presentation were dyspnoea (58.5%), syncope (31.3%) and presyncope (25.1%) (Table 1). Several patients presented with multiple symptoms.

Table 1. Distribution of patients according to presenting symptoms.

Indications were dominated by severe conduction disorders. High-degree atrioventricular block accounted for the majority of cases, including complete atrioventricular block in 75.6%. The distribution of indications is shown in Figure 2.

The mean delay between diagnosis and implantation was 38.3 ± 15 days (range: 2 - 398 days). The largest proportion of patients (37.5%) were implanted between 31 and 180 days.

AVB: Atrioventricular Block; SND: sinus node dysfunction.

Figure 2.Distribution of indications for pacemaker implantation.

Overall, dual-chamber pacemakers represented 49% of implants. Since 2022, their use increased markedly to 81.4%. The subclavian venous approach was used in 57% of procedures, while the cephalic approach was used in 43%. Septal positioning of the right ventricular lead was predominant (63%).

Peri-operative incidents included bleeding (5%), syncope (3%), lead displacement (1%) and atrial lead implantation difficulty (0.6%).

Primary implantation accounted for 93.7% of procedures, and generator replacement for 6.3%. Pacemakers were new in 84.4% of cases and reconditioned in 15.6%. The most commonly used manufacturers were Medtronic (59%) and Abbott/St Jude Medical (30%) (Figure 3). The devices were purchased by patients themselves or their families in 96.2%. Only 3.7% of patients benefited from private health insurance coverage.

Figure 3.Distribution according to the manufacturer of the implanted device.

The mean follow-up duration was 7 yeras, with a minimum follow-up of 1 month and a maximum follow-up of 15 years. The overall complication rate was low. Pocket haematoma, lead displacement and pocket infection each occurred in less than 3% of cases. Other complications were rare (Table 2).

Table 2.Pacemaker implantation characteristics.

The retrospective design may have resulted in missing data and heterogeneous follow-up. The absence of a national pacemaker registry limited long-term outcome assessment.

The establishment of a national registry, reinforcement of electrophysiology training and improved financial coverage are essential to further expand access to permanent cardiac pacing in Togo.