Pacemaker for Athletes

Hi everyone.

I am a 54 year old endurance cyclist, cycle guide and coach, who, 6 weeks ago, had a pacemaker implanted for 3rd degree heart block.

I have developed pain around the pacemaker in the chest, swelling in the left arm and purple bruising along the blood vessels around my left shoulder. I feared an infection or thrombosis and was checked in the local hospital and given the all clear to go home. However the pain, swelling and purple bruising still remain and it's uncomfortable at rest and to lift my left arm.

I was wondering how I should proceed now the hospital has already checked it and found no infection or blockage.

Thanks in anticipation.



Pain etc

by piglet22 - 2023-12-03 05:31:08


Things should have settled down by now and personally I have never experienced any real discomfort after two implantations.

I would get it looked at.

It seems to me that you were not given clear advice

by Gemita - 2023-12-03 06:19:10

Phil, did they tell you in the hospital what to do to try to ease your symptoms or give you a clear diagnosis for your symptoms?  I can only tell you what I experienced.

When we have a pacemaker implant and they feed leads through delicate blood vessels, these blood vessels can get traumatised.  Some of us even get partial blockages where the lead is placed and mother nature then intervenes and produces collateral circulation to by-pass the traumatised area.  This collateral circulation can look awful.  I have got noticeable ugly blue veins around my device/left upper arm, but this collateral circulation helps keep blood flowing adequately while we are healing. 

Before collateral circulation formed I had pain going across my collarbone, up into the left armpit and upper left arm which was uncomfortable.  Like you I had imaging and they told me there were no major blockages, but it was clear from my extensive vein formation what had happened.

All I can suggest, in the absence of any infection or any significant blockage that you are still healing, still developing alternative circulation to by-pass any trauma to your main blood vessel where the lead(s) have been placed.  While this is happening, don’t try to push too hard exercise wise.   Listen to your body.  Rest, ice to bring down any swelling while you are healing.

I would go back to your medical team and ask what more can be done to relieve your symptoms although only time can heal the damage to blood vessels and nerves that may have occurred.  I am now completely pain free but it took months.  You need clear advice how to manage this better?  I hope you heal quickly and can soon get back to your activities

Lack of advice from Doctors

by Philmtb - 2023-12-03 07:01:15

Thanks for your answers, they are extremely useful. I have been given very little advice or help since the implantation of my Pacemaker. After 2 weeks, my physician checked my device and told me I was free to do everything I wanted to and showed me the door. Worried, I asked him about raising my arm, lifting, swimming, cycling and other exercises and he told me I would need to do them as a 'normal' person would, whatever that was meant to mean. Therefore, his original advice was not helpful or even valid, arguably negligent.

I am scheduled to see this same physician tomorrow and I hope to get some proper advice. I will need to be quite forceful, because he has hardly talked to me pre or post operation and seems very disinterested and unsympathetic. Unfortunately, he is the only person in Mallorca that works with Pacemaker patients.

My arm is currently very swollen and uncomfortable and I keep getting bouts of light headedness. The hospital didn't give me any advice, just to wait the 4 days to ask my physician.

Your explanation, Gemita, makes a lot of sense and would certainly explain the blue veins forming. I also have discomfort raising my arms which seems to suggest swelling or muscular damage, but could be the swelling from the circulation issues.

I will start to ice the area and obviously take it easy until I have seen the physician again.



Things change, signs develop over time

by crustyg - 2023-12-03 08:36:50

If your L arm is swollen then there's a real problem - a normal PM + leads does NOT produce arm swelling unless there's been a complication.

If your hospital hasn't done a doppler ultrasound looking for a clot then that's the next step +/- bloods looking for biochemical evidence of a clot.

I wouldn't wait another four days to seek help but go back to the hospital and let them see the swelling for themselves.  It sometimes helps to measure the circumference on each arm (I suggest at the top of the upper arm) and a) keep a record of the sizes to see if there's a change and b) show the difference,

The lightheadedness is a worry.  I would certainly emphasise this when going back to the hospital.  Only about 2% of new PM implants are associated with complications, but they can be quite serious.  And if you're in the 2% then it's a 100% failure rate for you.

Don't delay.

Swollen arm Complications reply to crustyg

by Philmtb - 2023-12-03 09:37:19

When I went into the hospital 3 days ago, the hospital did an ultrasound but found nothing. However, they said the ultrasound could not go deep enough to check the subclavian vein. (I assume that's what the doppler ultrasound does)? They also tested my bloods, urine and heart. and took x-rays. 

While, I was there, the swelling went down and only today got worse again. Yesterday, I felt light-headed in the morning but was fine afterwards. I felt uncomfortable during the night and today the swelling in as bad or worse than it was before, with small bouts of lightheadedness.

I am due to see the treating physician at 4.30 pm tomorrow.

I have measured the size of both arms - 37cm compared to 30cm - so the arm is very swollen. If this gets worse then I will return to the hospital today.

Thanks for your excellent advice.

Hope for the very best Phil

by Gemita - 2023-12-03 10:25:32

I had a CT with contrast to rule out a significant blood clot Phil in the subclavian vein.  However I was already on an anticoagulant for Atrial Fibrillation so in many ways I had a level of protection.  

My main fear for you if this turns out to be a serious complication is that the earlier the problem is identified and treated, the better for your long term outcome. 

If the arm continues to swell or change colour, then you should seek urgent help and not wait to be seen.  Having prominent collateral veins in the area will be helping to maintain circulation, but it may not be enough.  Take good care and please stay in touch 

Deep Vein Thrombosis Diagnosed

by Philmtb - 2023-12-08 07:39:58

Thank you for all the advice so far, which really helped when making the decision to return to hospital to check for complications.

I went to the hospital on the night of 3 December and was diagnosed with DVT in the subclavian vein, where the Pacemaker leads were placed. Like with my initial Pacemaker fitting, this is a massive shock, not just because the chances of this complication are 1 in 100,000 but as I have a healthy heart in terms of structure, no family history, no previous medication and I am athletic. 

I stayed 2 nights in hospital, had several tests and was told I would need to be on blood thinners and potentially they would remove my 1st rib and / or muscle in the chest area to make more space between the Pacemaker and my Subclavian vein. This is because, as an ex-rugby player, I am still very muscular in the chest area.

Currently I have been placed on daily injections of Hibor 7500. My physician recommended I should take this for the next 6 months to avoid the potential for a further clot. My job as a Bike Guide is very physical and, apart from the riding, involves lifting up to 16 bikes onto van roofs and trailers. Therefore, I think being on blood thinners would present a danger of both external and internal bleeding. He will see me again in a few days to monitor the current clot. My arm swelling has reduced so I am improving.

I hope I can restart my recovery again and return to my cycle guiding job soon. I am currently taking steps towards finding another Physician on the island, as I have little faith in my current one. 


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