Long-term Effects of Early Shoulder Exercise After CIED Implantation

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.