BACKGROUND: Permanent pacemaker implantation is a life–saving procedure that is performed worldwide. There is paucity of reports on pacemaker implantation in south India. The aims of the study were to determine the indications for pacemaker insertion, the demographic distribution of the patients requiring it, the electrocardiographic (ECG) changes, and the management challenges. MATERIALS AND METHODS: Two hundred consecutive patients who had pacemaker insertion done by our team 2018–2019 were included in the study. The patients biodata, indications for pacemaker insertion,ECG changes, and the treatment profile were recorded. RESULTS: There was slight female preponderance 54(%) among the patients studied. Third–degree heart block was the indication in 82.5% of the patients and most patients did well with single lead ventricular pacing which is generally cheaper than the dual chamber pacing. CONCLUSION: The majority of bradyarrhythmia patients in this environment can be maintained on single lead ventricular pacemaker