Changes in pacemaker implantation indications, population ageing, the emergence of leadless pacing systems and atrioventricular block following transcatheter aortic valve implantation may have influenced recent implantation trends.

This nationwide study aimed to describe temporal trends and patient characteristics of permanent pacemaker implantation in France between 2018 and 2024.

All patients newly implanted with a permanent pacemaker between 2018 and 2024 were identified using the French National Health Data System (SNDS). Age- and sex-standardized annual incidence rates were calculated. Patient characteristics, hospitalization settings and device types were analysed, and national pacemaker prevalence was estimated for 2024.

In 2024, 492,583 patients were living with a permanent pacemaker in France (standardized prevalence of 645 per 100,000 population). A total of 51,739 incident implantations were identified (61.5% men; mean age 80.1 years), with 6.8% of procedures following TAVI. The median time to pacemaker replacement was 9.0 years (interquartile range 7.7–10.5). The age- and sex-standardized incidence rate slightly declined (83–73 per 100,000) over the study period, driven primarily by a reduction in implantations performed in private healthcare facilities. Although dual-chamber pacemakers remained the most frequently implanted devices, the use of leadless pacemakers within single-chamber systems has steadily increased since 2019 and was more frequent in less socioeconomically deprived populations, even after adjustment for comorbidity burden.

A modest decline in incidence of permanent pacemaker implantation was observed in France between 2018 and 2024, with a more pronounced decrease in private healthcare settings. The observed disparities, especially regarding access to leadless pacing systems, suggest potential differences in healthcare access or clinical practice patterns.