Background: A pacemaker detects heart pulses and sends electrical impulses to maintain normal heart rhythm. Temporary pacemakers treat transient arrhythmias, while permanent ones treat persistent arrhythmias. Aims of the study: To assess knowledge and reported practices regarding pacemaker among elderly patients. Subjects & method: Descriptive research design was used. Sample type: a purposive sample was used in this study. Setting: The study was conducted in Assiut Heart University Hospital. The total sample size was 200 elderly patients with pacemakers. Three tools were used. Tool (I): Structured interview questionnaire sheet divided into two parts: Part I: Patient's demographic data, Part II: Patient's medical data, Tool II: Patients Knowledge Assessment Questionnaire and Tool (III): Patient Reported Practices Assessment Questionnaire. Results: Total number of the studied elderly patients 200 with mean age 71.89and 51% of the elderly patients were men.  The current study findings showed that only 26.5% of the elderly patients had satisfactory knowledge and only 33.5% of the elderly patient's sample has adequate practices regarding pacemakers. There was highly statistical relation between total level knowledge and total practices at p-value Conclusion: The present study concluded that about three quarters of the elderly patients had poor knowledge regarding pacemaker and nearly two thirds of the elderly patients had inadequate practices regarding pacemaker. Recommendations: Implement comprehensive educational programs for patients before pacemaker implantation. And develop educational materials that are tailored to the specific needs and literacy levels of elderly patients regarding pacemaker.