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Introduction Data on the use of traditional permanent pacemakers (PPM) and events of mechanical complications(MC) in the elderly with nonischemic cardiomyopathy(NIC) is limited. We aim to understand the trends and risk factors of MC among de novo PPM implantations involving elderly NIC patients.Methods Procedures for PPM implantation were extracted from the National Inpatient Sample(NIS). We restricted our study to adults ages ≥60 years and with NIC. Cases with existing pacemakers or defibrillators were removed. Events of MC were found and the trends examined using the Cochran-Armitage test. We further constructed a multivariable regression model to estimate the roles of different comorbidities and variables for such an event.Results Between 2016 and 2021, there were 28200 PPM implantations conducted, amongst which 1085(3.8%) experienced MC. From 2016 to 2018, the incidence rose from 3.20% to 3.98%, followed by a drop in 2019 to 3.83%, and a subsequent rise during the first year of theCOVID-19 pandemic(4.52%). In the second year of the pandemic, year 2021, events of MC decreased to 3.87%(ptrend=0.017). The key factors that contributed to higher odds of MC included chronic kidney disease (CKD)(aOR 1.168, 95% CI 1.024–1.333, p=0.021), COPD(aOR1.236, 95% CI 1.062–1.438, p<0.01), liver cirrhosis (aOR 2.008, 95% CI 1.531–2.634, p<0.01), presence of valvular disease(aOR 1.236, 95% CI 1.085–1.407, p<0.01), and coagulopathy(aOR 1.565, 95% CI 1.296–1.890, p<0.01). On the contrary, we found fewer cases with MC among those insured by Medicaid(vs. Medicare)(aOR 0.331, 95% CI 0.175–0.627, p<0.01), classified as obese(aOR 0.732, 95% CI 0.609–0.880, p<0.01), smokers(aOR 0.694, 95% CI 0.603–0.799, p<0.01) or with dyslipidemia(aOR0.814, 95% CI 0.715–0.927, p<0.01).No sex based differences(aOR 1.092, p=0.173) or racial disparities (Black, aOR 1.053, p=0.621; Hispanics aOR 1.007, p=0.957) were noted. Similarly, diabetes(aOR 1.113, p=0.123) and hypertension(aOR1.189, p=0.100) did not show statistically significant results.The mortality rate among patients with MC was estimated at 3.2%(vs. 1.2%, aOR 2.594, 95% CI 1.798–3.742, p<0.01).Conclusion MC was a rare but severe complication that contributed to in-hospital mortality. As several comorbidities may influence events of having MC, additional studies are warranted to analyze their roles and find alternative solutions to reduce such complications and improve their short and long-term outcomes.