What questions should be asked to a patient after permanent pacemaker (PPM) implantation on day one?

From the Guidelines

After a permanent pacemaker (PPM) implantation on day one, it is crucial to ask your patient about their overall condition, potential complications, and adherence to post-procedure instructions to ensure optimal recovery and device function. When evaluating a patient on day one after PPM implantation, key questions to ask include:

• Are you experiencing any pain or discomfort at the implant site?
• Have you noticed any swelling, redness, or drainage around the incision?
• Are you feeling any unusual sensations like palpitations or dizziness?
• Have you had any fever since the procedure?
• Are you able to move your arm on the side of the implant without significant pain?
• Have you been following the activity restrictions given to you after the procedure? These questions help assess for potential early complications such as infection, lead dislodgement, or hematoma formation, as suggested by guidelines for cardiac pacing and cardiac resynchronization therapy 1. Additionally, it is essential to remind the patient to:

• Keep the incision site clean and dry
• Avoid lifting the arm on the implant side above shoulder level for 4-6 weeks
• Take prescribed antibiotics if any
• Schedule a follow-up appointment for wound check and device interrogation, with the schedule for long-term follow-up being dependent on parameters such as the initial indication for pacing, the patient’s overall clinical condition, and the type of pacemaker implanted 1. Addressing these points early can prevent complications and ensure proper healing and device function, ultimately reducing morbidity, mortality, and improving quality of life.

From the Research

Post-Implantation Assessment

The following questions should be asked to a patient after permanent pacemaker (PPM) implantation on day one:

• Are you experiencing any symptoms such as pain, swelling, or redness at the implantation site? 2
• Have you noticed any changes in your heart rhythm or are you experiencing any palpitations? 3, 4
• Are you taking your prescribed medications, including antibiotics, as directed? 2
• Do you have any questions or concerns about your pacemaker or the implantation procedure?
• Are you experiencing any signs of infection, such as fever or chills? 2, 3

Monitoring and Follow-up

It is essential to monitor the patient's condition closely after PPM implantation, including:

• Checking the pacemaker's function and adjusting the settings as needed 3, 4
• Monitoring for signs of infection or other complications 2, 3
• Assessing the patient's quality of life and functional capacity 5, 6
• Providing education and support to the patient and their family members 6

Patient-Specific Factors

The following patient-specific factors should be considered when assessing a patient after PPM implantation:

• Age and overall health status 3, 5
• Presence of underlying medical conditions, such as cardiac comorbidities or atrial fibrillation 3, 5
• History of cerebrovascular accident or other neurological conditions 3
• Use of anticoagulant drugs or other medications that may interact with the pacemaker 3