From the Guidelines
After having a pacemaker implanted, patients should follow several important care guidelines to ensure proper healing, prevent complications, and maintain optimal pacemaker function. The most recent and highest quality study on this topic is from 2013 1, which provides guidelines for device-based therapy of cardiac rhythm abnormalities. According to this study, patients should keep the surgical site clean and dry for about a week, watching for signs of infection such as redness, swelling, warmth, or drainage.
Key Recommendations
- Avoid raising the arm on the side of the pacemaker above shoulder level for 4-6 weeks to prevent lead dislodgement.
- Take all prescribed medications, including antibiotics if given, and pain relievers as needed.
- Attend all follow-up appointments, typically scheduled 1-2 weeks after implantation, then every 3-6 months initially.
- Carry a pacemaker identification card at all times.
- Avoid strong magnetic fields and direct pressure on the device site.
- Most patients can gradually return to normal activities within a few weeks, but should avoid contact sports and activities with risk of trauma to the chest.
- Report any symptoms like dizziness, fainting, chest pain, hiccups, or muscle twitching immediately.
Additional Considerations
Modern pacemakers are generally compatible with most household electronics, but patients should maintain a 6-inch distance between cell phones and the device 1. The frequency and method of follow-up are dictated by multiple factors, including other cardiovascular or medical problems managed by the physician involved, the age of the pacemaker, and geographic accessibility of the patient to medical care 1. Some centers may prefer to use remote monitoring with intermittent clinic evaluations, whereas others may prefer to do the majority or all of the patient follow-up in a clinic 1.
Follow-up Schedule
The schedule for clinic follow-up should be at the discretion of the caregivers who are providing, but a more extensive clinic follow-up usually includes assessment of the clinical status of the patient, battery status, pacing threshold and pulse width, sensing function, and lead integrity, as well as optimization of sensor-driven rate response and evaluation of recorded events 1.
From the Research
Post-Pacemaker Implantation Care
- Patients with permanent pacemakers need to be aware of potential pacemaker interactions at work and in other environments, including the hospital environment, which can host diagnostic and therapeutic sources of electromagnetic interference that can disrupt normal pacemaker function 2.
- After cardiac surgery, patients who require permanent pacemaker implantation should be identified, and predictors for pacemaker requirement, such as left bundle branch block and aortic valve replacement, should be considered 3.
- For patients who are pacemaker dependent after surgery, implanting a permanent pacemaker at 5 days after surgery can enable early mobilization and early discharge 3.
- Temporary pacemakers can be used in critical care settings, including epicardial pacemakers after cardiac surgery and transvenous temporary pacemakers for emergent treatment of bradyarrhythmias 4.
- Critical care nurses should be equipped with the knowledge to care for patients immediately postoperative cardiac implantable electronic device placement and for patients admitted to critical care units with these devices already in place 5.
Medication and Pacemaker Interaction
- The use of metoprolol in patients with permanent pacemaker implantation after surgery can reduce the expansionary remodeling of the left atrium and have less impact on the QT-dispersion and Pd time 6.
- Metoprolol can also improve myocardial remodeling and cardiac function in patients with permanent pacemaker implantation, with lower NT-proBNP and hs-CRP levels, and reduced incidence of adverse events 6.
Environmental Considerations
- Patients with pacemakers should be aware of potential environmental interactions, including the use of cellular telephones and magnetic resonance imaging, which can disrupt normal pacemaker function 2.
- Hospital environments can pose a risk to pacemaker function due to the presence of diagnostic and therapeutic sources of electromagnetic interference 2.