EARLY MOBILIZATION AFTER PACEMAKER IMPLANTATION (EMAPI).

Aim: This trial aimed to assess the safety and feasibility of early mobilisation and posibility of same-day discharge following permanent pacemaker implantation.
Methods: The Early Mobilization After Pacemaker Implantation (EMAPI) trial was a prospective, randomized, monocentric study involving 200 patients undergoing pacemaker implantation. Participants were randomly assigned to either the Early Mobilization (EaM) arm, with 4 hours of rest post-procedure, or the Late Mobilization (LaM) arm, with 16-24 hours of immobilisation. Primary endpoints included a composite of common complications such as haematomas, major bleeding, wound infections, pneumothorax, and lead dislodgement. Secondary endpoints compared the incidence of individual complications between the two groups. Follow-up period was at 1 and 6 months.
Results: Of the 200 enrolled patients, follow-up was completed for 191 (95.5%) at 6 months. 150 patients received a dual lead device and 50 received a single lead device. The incidence of primary composite complications was similar between the EaM (4 cases, 4%) and LaM (7 cases, 7%) arms (p=0.548). There were no significant differences in individual complications such as lead dislodgement or wound infections (atrial lead dislodgement 2 vs 2; EaM vs LaM, ventricular lead dislodgement 0 vs 0; EaM vs LaM, wound infection 1 vs 0;, EaM vs LaM). Technical parameters remained stable across both groups, without any significant diferences like drop of sensing, or growth of stimulation threshold.
Conclusion: The EMAPI trial provides strong evidence supporting early mobilisation and posibility same-day discharge after pacemaker implantation. This approach can potentially streamline care, improve patient outcomes, and reduce healthcare costs. With data from other similar trials, this procedure can be determined as a new standard of care.