Bengaluru : Simultaneous DBS surgery and Leadless pacemaker implantation on a 75-year-old patient. The patient presented with overlapping neurological and cardiac challenges. This patient, who had a long-standing history of Parkinson’s disease, recently experienced acute worsening of symptoms, including debilitating tremors and severe mobility limitations. This had impacted his daily life causing dependency in day-to-day activities.
In consultation with the family, the patient underwent evaluations such as a Deep Brain Stimulation (DBS) evaluation, pre-operative screening, and subsequent 24-to-48-hour ambulatory Holter ECG monitoring. The findings revealed features of a Tachy-Brady Syndrome (Sick Sinus Syndrome-SSS) with fast irregular heartbeat, in the form of atrial fibrillation interspersed with prolonged sinus pauses and sinus bradycardia that was causing the heart rate to drop critically between 35 and 40 beats per minute. SSS in the elderly can cause cerebral stroke, heart failure, syncope/blackouts and falls if not treated appropriately, posing a significant pre-operative challenge for someone who’s planned for DBS.
Following a detailed assessment, a multidisciplinary team comprising Dr. Guruprasad Hosurkar, Director & Lead Consultant in Neurology and Head of Parkinson’s Disease & Movement Disorder Programme; Dr. Raghuram Gopalakrishnan, Director & Senior Consultant, Head of Stereotactic and Functional Neurosurgery; Dr. Deepak Krishnamurthy, Director & Lead Consultant – Cardiology; Dr. Saikat Kanjilal, Consultant – Cardiology; and senior anaesthetists carefully planned and executed synchronized, simultaneous procedures—Deep Brain Stimulation (DBS) to alleviate advanced Parkinson’s symptoms and restore motor function, alongside Leadless Cardiac Pacemaker implantation to manage Sick Sinus Syndrome.
Conventionally, transvenous pacemakers may pose challenges in patients undergoing DBS implantation because of the potential for electromagnetic interference (EMI) between the cardiac implantable electronic device and the DBS system. In addition, the presence of multiple pulse generators within the chest can complicate device positioning and future imaging considerations. To mitigate these concerns, the medical team selected a leadless pacemaker, the MICRA system. The procedure highlights the integration of specialized cardiac and neurological care required to safely navigate complex, co-occurring conditions in aging patients
Dr. Guruprasad Hosurkar, Director & Lead Consultant in Neurology, Head of Parkinson’s Disease and Movement Disorder Programme, KIMS Hospitals, Mahadevapura, said, “Given the patient’s complex clinical condition, synchronized, dual procedures were essential. By taking a meticulously planned approach and multidisciplinary collaboration, we successfully accomplished the surgery while ensuring all potential risks were effectively managed—making this procedure rare and first of its kind in Indian healthcare.”
“Patients requiring both cardiac pacing and neuromodulation often present unique technical and peri-procedural challenges. By carefully planning the procedure and ensuring compatibility between the two devices, we were able to safely complete both implantations in a single session; thereby negating the need for repeated hospital admissions, multiple exposures to anaesthesia, and accelerating recovery. This case demonstrates our commitment to bringing advanced therapies to our patients safely and effectively,” added Dr. Saikat Kanjilal, Consultant – Cardiology, KIMS Hospitals, Mahadevapura.
Following the successful completion of the procedure, there has been considerable improvement in the patient’s symptoms in terms of tremors and movements, control of heart rhythm, along with the quality of his life.
This particular case highlights the KIMS Hospitals, Mahadevapura’s ability to provide highly advanced care along with utilising new medical technology in conjunction with other specialities.