Continental Cartography of Permanent Pacemaker Use in Africa: A Scoping Review

Permanent pacemakers are essential for symptomatic bradyarrhythmias, but access, practice patterns, and outcomes across Africa are poorly characterized. We performed a scoping review of PubMed, African Index Medicus, and African Journals Online through July 19, 2025, to map published evidence on pacemaker implantation, practice, and outcomes and to identify service and research gaps. Twenty-seven studies (data collection 1963–2025; publications 1972–2025) met inclusion. Reported patient ages spanned 11–96 years and follow-up ranged from 6 weeks to 387 months. Complete heart block, sick-sinus syndrome, and high-degree AV block were the most common indications; hypertension and diabetes were frequent comorbidities. Device-condition reporting was limited: five studies documented reused devices with cohort reuse proportions of 3.9%, 6.4%, 50%, 52.2%, and 100%. Single-chamber systems appeared in 17 studies and dual-chamber systems in 16, with VVI/VVIR and DDD/DDDR dominant. Subclavian access was most frequently reported; cephalic and axillary approaches were used variably. Common presentations included syncope, dizziness, and dyspnea. Reported complications included pocket/lead infections (0.4%–16.7%), lead displacement (0.7%–6.7%), and pocket hematoma (0.6%–13.3%); all-cause mortality ranged 0%–20% and device-attributable deaths were rare. The literature is heterogeneous with wide regional variation, limited reporting standards, reliance on mission activity, and documented delays and pre-implant deaths. Priority actions include standardized reporting, regional registries, decentralized capacity building, local training, and validated protocols for safe device reuse and donation to expand equitable access.