Appropriateness of Sling Immobilization to Prevent Lead Displacement After Pacemaker/Implantable Cardioverter-Defibrillator Implantation

Abstract

After pacemaker/implantable cardioverter-defibrillator (pacemaker/ICD) implantation, patients are often required to immobilize the affected arm with a sling to minimize the risk of lead displacement. We examined whether performing a resistive range-of-motion exercise protocol after pacemaker/ICD surgery would result in lead displacement and, therefore, whether sling immobilization and activity restrictions are justified. Ten subjects who had undergone pacemaker/ICD surgery performed four individual resistive range-of-motion exercises (three sets of 10 repetitions for each: one warm-up set without weight and two sets with a 1- or 2-pound hand weight) with the affected arm prior to hospital discharge. For each subject, an electrophysiology nurse specialist used a noninvasive device programmer to evaluate surgical lead placement before and after the exercises. As an adjunct to the study, we queried clinicians at 48 US hospitals about sling immobilization and activity restrictions after pacemaker/ICD implantation at their institutions. No lead displacement occurred after the weightlifting exercises were performed. Based on these results in a small group of patients, it appears that requiring the use of a joint immobilization sling is overly restrictive, promotes fear, and hinders recovery. We encourage the development of consistent discharge instructions that will promote early mobility and a safe and rapid return to normal activities.

Wound Management and Restrictive Arm Movement Following Cardiac Device Implantation — Evidence for Practice?

“…In their pilot study, Naffe et al (2009) asked their study subjects to perform exercises that involved lifting 1-or 2 pound weights and raising their arm on the accessed side above shoulder level and above the head in a "military press", "diagonal raise", "overhead triceps extension" and "frontal raise". No lead displacement occurred, suggesting that there was no evidence for immobilising the arm postoperatively [10].…”

“…Common practice remains to encourage limited arm movement after cardiac device implantation, as this is thought to prevent lead displacement. Typical advice ranges from "Don't use your arm for 24 hours", "Don't lift more than 10 pounds for 2 weeks" to "Don't lift your arm over your shoulder for 6 weeks" [13]. Patients may get disparate advice from different members of the clinical team, which can lead to further confusion.…”

Postoperative opioid prescription patterns and new opioid refills following cardiac implantable electronic device procedures

“…Appropriate postoperative patient education on arm movement is important, as prolonged restricted arm movement may lead to adhesive capsulitis (frozen shoulder) leading to prolonged postoperative pain. 30 Multiple statements on recommendations for opioid use in managing acute postoperative pain have been published. 22,31 The Dr. Robert Bree collaborative categorized procedures into various types, based on expected duration of recovery.…”

Predictors of shoulder limitations and disability in patients with cardiac implantable electronic devices: Importance of device size

“…11 However, after the first year following implantation, limitations become permanent and are not self-resolved. 12,13 Although studies have shown that early mobilization after CIED implantation is safe, [14][15][16][17] some physicians habitually prefer to temporarily immobilize the arm with a sling or restrict arm movements above the shoulder level. 18,19 Also, patients may extend this period of their own accord to avoid the risk of device malfunction.…”