Evaluating the Safety and Effectiveness of Early Cardiac Rehabilitation Following Permanent Heart Pacemaker Implantation: A Pilot Study

Background: This pilot study aimed to evaluate the safety, feasibility, and preliminary effectiveness of early supervised cardiac rehabilitation (CR) initiated within 7 days after permanent pacemaker implantation. Methods: A prospective, non-randomized pilot study was conducted using consecutive sampling to enroll 100 adults undergoing first-time pacemaker implantation. Participants were assigned to either an early CR group or standard care. The primary outcome was safety, including lead dislodgement, arrhythmia, or syncope. Secondary outcomes included changes in 6-minute walk distance (6MWT), SF-36, and HADS scores. Results: No exercise-related adverse events occurred. Compared with standard care, the early CR group showed greater improvement in 6MWT distance (mean difference: +62.4 m; 95% CI: 38.1– 86.7; p < 0.01), SF-36 PCS (+5.0; 95% CI: 0.7– 8.9; p = 0.03), and HADS-anxiety (– 2.4; 95% CI: – 4.6 to – 0.2; p = 0.04). Conclusion: Early CR after pacemaker implantation appears safe, feasible, and associated with improved functional capacity and psychological well-being. Limitations include the non-randomized design, single-center setting, and short follow-up. Larger randomized trials are needed. Keywords: Pacemaker, cardiac rehabilitation, exercise therapy, functional recovery, pilot study