Background: Pacemaker may be a supportive therapeutic modality used to control long-term cardiac rhythm problems to save patients' lives from complications. Nurse plays an important role for caring cardiac pacemaker patients. The study aim was to evaluate the effect of intervention protocol on nurses' knowledge, practices, and patient's outcomes with Permanent Pacemaker Implantation. Research design: Quasi experimental pre – post assessment Setting: The study was carried out in Cardiac Intensive Care Unit, Cardiology Department, and outpatient clinics at Zagazig University Hospitals. Subjects: a convenience sample of all available nurses (40 ) working at the previous mentioned setting, and 40 patients with implantable pacemaker in the setting. Tools for data collection three tools were used tool I, Interview nurses questionnaire, tool I, an observational checklist, and tool III, patient interview questionnaire to assess adherence with pacemaker and activity daily living. The results showed statistically significant improvements in the knowledge and practice of nurses at the post test (p<0.001), with statistically significant strong positive correlation (r=0.567) between studied nurses. Also, across all aspects of patients adherence care practice and performing activity daily living after implementation there were also, statistically improvement (P =0.000*). In multivariate analysis, the intervention was a statistically significant positive independent indicator of the improvement in nurses’ knowledge and practice, and patient's outcome. Conclusion, implementing nursing intervention protocol for caring patients with implantable pacemaker is efficient in improving the knowledge and practice of nurses, which is a better adherence with pacemaker care activities and increase independency for performing activity daily living. Recommendation intervention protocol can be used in specific settings. Further research is proposed to examine the effect of the implementation of this protocol on reducing the incidence of complications due to non-adherence after implantation of pacemaker.