@leenag I had a pacemaker installed a few days after my septal myectomy (at age 73) in July 2025.

Here is an excerpt from my post of a few months ago:

"I turned out to be one of the five to ten percent of septal myectomy patients for whom a pacemaker would be required after surgery, even though they did not need a pacemaker before surgery.

Apparently everyone, after a septal myectomy, wakes up wired to an external pacemaker that sits on or near the hospital bed. At some point after the patient wakes up in the cardiac ICU, the pacemaker is turned down, and the team looks to see whether the heart resumes normal rhythms. If it does not, they turn the external pacemaker back on, and keep checking periodically for a couple of days. In my case, due to what’s called 'heart block,' it became apparent that my heart was not going to beat more than 40 beats per minute on its own, so four days after my septal myectomy a pacemaker was implanted in my upper left chest and wired to the heart."

My surgeon decided that since I needed the pacemaker, he would install a combination pacemaker/defibrillator, although Afib had not been a problem for me before the surgery. The implant is electronically monitored remotely.

I had a couple of incidents of Afib shortly after the surgery (as detected by the monitoring -- I did not feel the Afib, and the Afib was not severe enough to activate the defibrillator). The last Afib incident was in September, about 6 weeks after the surgery. I am on a blood thinner now, but if I continue to have no Afib for a year (through this September) the docs say I can probably discontinue the blood thinner.

I have now been back at the gym for several months (4 or 5 times a week), and back at as high a level (or higher) of aerobic activity as I was before I became symptomatic with HCM about two years ago.

I must admit that at first it was a mild downer to learn I would need an implant. Pre-surgery I had visions of being entirely "treatment free" after the surgical recovery period.

But I got over that quickly, and came to appreciate and focus on my good fortune at being a beneficiary of the medical advances of recent decades.

I gather from your post that your surgery is upcoming. Good luck with it! I have no regrets about mine.

@leenag Yes! Here is my experience: I did have an ICD, named it Buddy, installed about 4 months after my septal myectomy. Remember, our lucky hearts undergo a good amount of trauma during a septal myectomy! A couple of weeks after the surgery I developed dizziness and giddiness, also had a couple of syncope, it took a long time (too long) to figure out why. After wearing a Halter for 4 weeks and pressing a button each time I felt dizzy, it was determined that I was experiencing arrythmias. In my opinion, I should have been fitted with the Halter when the dizziness did not go away after a week or two, not 4 months later. Now, the very eloquent, informative and helpful @baystater101 posted an excellent response to your question. You may also read more by placing in your browser "Pacemaker after Septal Myectomy."