Cardiologists are increasingly encountering oldest-old patients with rhythm disturbances requiring implantation of a pacemaker, but few data exist regarding patients aged 90 years and over.

To analyse procedural complications, evaluate the long-term survival of nonagenarians after a first implantation of a pacemaker, and identify predictors of mortality in this population.

Retrospective study of 1326 patients aged 90 years and over from two centres who underwent first implantation of a pacemaker between June 2010 and February 2015. The primary endpoint was all-cause mortality. Secondary endpoints were immediate and long-term complications after implantation.

A total of 104 patients, average aged 92.7±2.8 years, were included; 63.8% had a single-chamber and 36.2% had a dual-chamber pacemaker implanted. Median survival was 31 months (2.6 years, 95% confidence interval (CI) 21.7–40.3). Two-year survival was 61.9%. Overall, 3.8% of patients had complications, including 0.95% serious complications related to the procedure. Age>92 years at the time of implantation, body mass index (BMI)<18.5kg/m², Charlson comorbidity index≥3 and non-physiological pacing were found to be predictors of mortality.

First-time implantation of a pacemaker is safe in patients aged 90 years and over. Complications and mortality up to 2 years after implantation are not related to the pacemaker. Charlson comorbidity index and BMI are independently related to survival.