Pacemaker "Dos and Don'ts" after surgery

I have had a dual chamber pacer for 28 years. It was inserted when I was 27 years old. My atrial lead cracked many years ago and was replaced. I was in the office recently to have a check and was told that my ventricular lead was older than the he was (Medtronic rep). Yay for me. I played soccer until I was in my early 40's and retired before I could mess up a knee, but continued to golf, fish, and lift weights. As you can understand, my 28 year old lead survived a lot of serious activity. I cannot speak to your situation/condition, but I can tell you that I changed nothing after the original pacemaker was inserted. I am having my 5th generator inserted in 2 weeks, and I don't even know it's there. I am fortunate that I only use the pacer < 1% of the time, but I'm sure glad it's there when I need it. Best of luck,

@sbhbill
Great for you and your success. I think we both agree staying active is a key.

What my EP advised me was everyones veins in their heart are different in terms of twist and turns. My lead that came out he could not get it where he wanted to. It came out. So I had what a surgery where they go in your chest from the side, deflate your lung, and put a lead directly on heart. That fixed the issue until that lead bccame compromised and such a high inpedince it was shut off. I then had a new one put in through normal way (veins).

I was done static not screw in. It moved slightly and they changed he way it pulses heart and correcting the issue. I just go a notice from Mayo cllinic about my leads. It stated Boston Scientific was having problems with their leads becoming calcified. Not sure how that will affect me and my leads which are approaching 20 years old.

I have 3 years left on battery and have no idea what I will get 3 years from now as teh devices have improved so much over time. I was told would not longer have home monitor device as information would be sent to my phone.

Trying to keep my phsical fitness routine but now as 78 the legs mostly really starting to get weaker and not happy with all my exercising.

I had my pacemaker put in nine months ago for low heart rate that caused high blood pressure I felt like it was inevitable because everyone else in my family had a pacemaker, but I don’t think it was an emergency situation or probably didn’t really have to happen at that time knowing what I know now I would not have done it when I did I do not feel any better now that I did before. I wished I had given medication for the high blood pressure another chance sleeping is a real problem for me and the fatigue that I feel just frustrating but you definitely need to take your doctors advice. If your doctor tells you you need a pacemaker you definitely should get it. My doctor told me it was up to me. He wouldn’t be mad at me if I didn’t get it, I just decided that it was inevitable since everybody in my family had one that I would eventually have to have it and then it would be easier to have it now instead of waiting until I was older. I was 75 when I got it.

@kb49
Are you seeing a Electrophysiologist (EP). If not you should be. They are the cardiologist experts in electricl functions of heart.

My experience with this is I have had a ICD/Pacemaker since 2006. I am on my 3rd one. I think everything that can go wrong and what you can experience I have gone through.

Most of the time a ICD is recommended when EF gets around 30. This is what my cardioloigsts and EP gave me as guidelines. Now of course many other things could require a ICD not just a low EF.

A pacemaker is to keep the heart beating at a certain rate. Mine keeps my heart rate (HR) from going below 70 and not above 160. I am on medication that without a pacemaker my HR would be in 30s. That was causing a lot of PVCs and arrympthmias.

You stated you have a low heart rate. If too low that would be where most cardioloigst would recommend a pacemaker. Some with very low HR can be dizzy, lack energy, and prone to arrymthmias and tachacardia. This comes from my EP not me as far from a medical expert.

If I read your post correctly you had low heart rate and high blood pressure. Since we don't have your medical and mental health history which your doctors do those reasons and anything else you should discuss with your medical doctors who do know your mental and medical history.

I was seeing a regular cardiologist when he suggested the pacemaker. I then went to Mayo Jacksonville for a second opinion. I had an hour office visit with a EP who not only recommended a ICD but the pacemaker as well. He then referred me to May Jackonville heart failure doctor who concurred with EP but recommended changing my medications.

At that point I turned my medical treatment over to Mayo and follow their recommendattions. That was almost 25 years ago. My EF has remained steady for last 10 years and I am very active physically exercising 6 days a week for 1-2 hours.

By the way the surgery to have it put in is consider minor sugery. Most probably you will go home the same day. I have had three surgeries and another upcoming one in 2-3 years.

I am a 67 yr male and had an ICD implanted in July of 2025 due to a diagnosis of Sustained Ventricular Tachycardia. I do not have any serious underlying heart disease. I was also previously very active with gym workouts, raquetball, hiking, and volunteered doing trail maintenance weekly. Others have described the first 2-3 weeks after surgery. I wanted to get back to my previous activity level. There was a wide range of recommendations and restrictions from other patients, doctors, device clinicians. Golf, tennis, and pull-ups have been mentioned as bad activities. The main concern is the leads going to the heart, not just dislodging them, but also long term wear where they enter between collar bone and rib. So some upper body repetitive motions can also be a concern. After surgery, they encouraged walking, and did not place a limit, so I immediately worked my way up to 7 miles a few days per week, while keeping tabs on pulse rate with a smart watch, keeping it below 150. After 2 weeks, I headed back to gym with my wife tagging along to help me build confidence as I learned how the device (or my heart) might react. Started on incline treadmill (walking) again watching pulse rate. After no issues for 2 weeks, I started stair climber which I find more demanding on the heart, but still no issues. Then I started to add weights, legs first, then upper body, lighter than I did previously. I shied away from movements that would cause the leads to be stretched, or did them very slowly. At 4 weeks, I did an easy hike, at 5 weeks a moderate hike, at 7 weeks a difficult hike, at 9 weeks I volunteered for trail work and worked all day including a bunch of upper body work. I did not have any issues with the ICD during all of this. I think the main idea is to ramp up activity according to your condition and goals. This discussion was with respect to the physical ICD. If you have a serious heart condition, of course that will have its own concerns and recommendations. Hope all goes well for you.

@jc76 i’m not seeing anybody. I haven’t seen anybody since six weeks after my surgery. How often should I be seeing someone?

@kb49 As jc76 noted, you should definitely be seeing an electrophysiologist to see if your PM has been programmed correctly.

@kb49 My dad's female companion had a pacemaker installed four weeks ago. She was to go to the local cardiac lab a few miles away at the four week mark for a checkup. I can't say that four weeks is standard, but I would guess that four weeks is about as long as a new pacemaker patient should go for that initial look-see.

Hello @kb49
I just reviewed the general instructions I received from the electrophysiologist before I had the surgery. I have summarized them:

"After implant, you'll have an initial check within 1 to 6 weeks to assess the incision site and device function, with subsequent in-person or remote follow-ups every 3 to 12 months depending on your device type and if remote monitoring is used. The exact schedule is personalized, so your electrophysiologist will provide specific instructions and a follow-up plan based on your implantable cardiac electronic device.
Initial Follow-Up
Within 1-6 Weeks: You will have an in-person visit shortly after the implant to check the incision and ensure the device is functioning correctly. This visit is crucial for detecting early complications like bleeding or infection.
Regular Follow-Up Schedule
General Guidelines: After the initial visit, follow-up frequency varies by device:
Pacemakers (PM/CRT-P): Every 3 to 12 months, with in-person checks every 6 to 12 months if remote monitoring is used.
Implantable Cardioverter-Defibrillators (ICDs/CRT-D): Every 3 to 6 months, with in-person checks every 3 to 6 months if remote monitoring is used.
Remote Monitoring: If you use remote monitoring, you'll have fewer in-office visits, typically once or twice a year, while the device continues to send data to your care team.
When to Contact Your Doctor
You should also contact your electrophysiologist immediately if you experience any of the following symptoms:
Redness, swelling, or drainage from the incision site.
A fever.
Dizziness, chest pain, or shortness of breath.
Symptoms similar to what you had before the implant.
Any shock from an ICD or other unusual device activity."

As you can see, these are very generalized instructions. What type of device you have as well as your personal diagnosis affect much of the follow up. In my case, I have had my device for just over 3 years. I have a CRT-D and I also have remote monitoring enabled on my device.
During the first year, I had saw the electrophysiologist every 6 months. After that, I have had annual in person check ups during which time the device's data is downloaded and any adjustments, if needed, are made at that time. That check up is followed 6 months later by a remote data download initiated by the clinic. If the remote transmission does not flag any issues, I will then return to the clinic for my next in person annual check up in August, 2026.
I do not always physically "see" an electrophysiologist each time but my downloaded data is always reviewed by one and I receive a copy of his/her report.
If you are able to have remote check ups, you will save a great deal of time. Not all devices are, however, enabled to do this. A friend of mine who has a two chamber pacemaker (without a defibrillator) has his device checked, in person, annually. His pacemaker is not capable of remote monitoring.
In between, I see a cardiologist for any medication adjustments, necessary bloodwork, or for annual echocardiograms.
Best wishes.

@cottagecountry thank you for your input my device has transmitted scheduled reports to the clinic twice since my surgery I haven’t heard anything so I guess everything is working as it supposed to. I’m disappointed I don’t have more energy but it is what it is. Thank you so much for the information