Long-term Effects of Early Shoulder Exercise After CIED Implantation

Effects of Early Shoulder Exercise on Functional Recovery After CIED Implantation: A 3-Year Randomized Cohort Follow-Up

Shoulder dysfunction frequently occurs after cardiac implantable electronic device (CIED) implantation, adversely affecting quality of life. While early postoperative exercise is known to be effective in the short term, data on long-term durability is limited. This 3-year longitudinal follow-up study evaluates the sustained benefits of pendulum exercises (PE) and stretching & strengthening exercises (SSE) compared to standard care. We assessed shoulder range of motion, grip strength, and quality of life to determine if early mobilization provides lasting functional recovery without compromising lead safety.

This study is a 3-year follow-up of a randomized controlled trial involving patients who underwent transvenous subcutaneous prepectoral CIED implantation. Participants were originally randomized into three groups:

• Control group (standard care),
• Pendulum Exercise (PE) group,
• Stretching and Strengthening Exercise (SSE) group.

The exercise protocols were initiated 2 weeks post-implantation and continued for 6 weeks. In this longitudinal phase, patients were re-evaluated at a 3-year follow-up mark. Functional outcomes were measured using grip strength (kilogram-force), shoulder range of motion (flexion and abduction degrees), Visual Analog Scale (VAS) for pain, QuickDASH for functional disability, and the SF-36 survey for quality of life. Long-term safety was also monitored by assessing lead-related complications (dislodgement or fracture) over the 3-year period.

Inclusion Criteria:

• Patients aged 18 years or older.
• Patients undergoing first-time transvenous subcutaneous prepectoral CIED (Pacemaker, ICD, or CRT) implantation.
• Patients with no prior history of major shoulder surgery or chronic shoulder pathology on the side of the implantation.
• Patients who are capable of understanding and performing the prescribed exercise protocols.
• Patients who provided written informed consent to participate in a 3-year longitudinal follow-up.

Exclusion Criteria:

• Patients undergoing revision or replacement procedures of existing devices or leads.
• Pre-existing frozen shoulder, rotator cuff tear, or severe adhesive capsulitis on the implantation side.
• Neurological or musculoskeletal disorders affecting upper limb function (e.g., prior stroke sequelae or severe cervical disc herniation).
• Cognitive impairment or psychiatric disorders preventing cooperation with the study protocol.
• Lead-related complications (e.g., dislodgement or cardiac perforation) occurring within the first 2 weeks post-implantation, prior to the initiation of the exercise program.