Early Mobilization After Cardiac Implantable Electronic Device Implantation

Background: There is no information or guideline regarding mobilization of patients after cardiac implantable electronic device (CIED) implantation. In the present study, we tested a new protocol concerning the mobilization of patients 4 hours after receiving a CIED.

Methods: consecutive patients who underwent CIED implantation were randomized in a cluster fashion to mobilization after 4 hours (Early group) or 24 hours (Late group). Clinical, device related parameters were collected as well as complication rates and patients` satisfaction based on a standard validated questionnaire. Primary endpoint included lead dislodgement requiring reposition, and fall or syncope. Secondary endpoints included patient satisfaction grade, significant change in parameters not necessitating reposition, and urinary retention.

Results: One hundred and ninety patients were included. Baseline characteristics were comparable between the two groups. Complication rates were comparable, with two lead dislodgements in the Early group and three in the late group. Device parameters were stable in both groups. More patients in the Late group reported on significant pain (86.2% vs. 70.3%, P=0.058), and difficult in urination (5% vs. 1%). One patient in the late group required insertion of urinary catheter. Six patients in the Late group could not stay in bed and were mobilized earlier (protocol deviation). Patients` satisfaction questionnaire grades were comparable between groups. However, patients in the Late group more often reported on perception of dependency (p=0.045).

Conclusion:

Early mobilization protocol seems feasible and safe, without impacting on implantation success. Patients whom were mobilized earlier reported less pain and urinary difficulties. Protocol with prolong immobilization may be difficult to enforce and occasionally resulted in disagreement between patients and nursing staff.