Mumbai/Kolkata: A 70-year-old man suffering from complete heart block and a life-threatening pacemaker infection has successfully received a new lease of life at Manipal Hospital Salt Lake through an advanced dual-chamber leadless pacemaker implantation. The complex procedure was performed by (Prof.) Dr. Rabindra Nath Chakraborty, Senior Consultant – Interventional Cardiology and Head – Department of Cardiovascular Services, Manipal Hospitals Kolkata.
The patient, a resident of Bihar, was initially diagnosed with complete heart block after experiencing repeated episodes of unconsciousness and a dangerously slow heart rate. Considering the severity of his condition, doctors implanted a dual-chamber MRI-compatible pacemaker. Following the procedure, it was discovered that the patient was completely dependent on the pacemaker, as his hearts natural electrical conduction system was no longer functioning.
However, within two weeks of the implantation, the patient developed a severe infection at the pacemaker pocket site below his left collarbone. Despite prolonged antibiotic treatment, wound care, and medical management across multiple hospitals in Bihar, Delhi, and Patna, the infection failed to resolve. Over time, the pacemaker device became exposed through the skin, creating a critical clinical challenge as the patient could not function without pacing support.
After evaluation at Manipal Hospital Salt Lake, (Prof.) Dr. Rabindra Nath Chakraborty and his team decided on a specialised treatment approach. Since removal of the infected pacemaker without an immediate alternative could put the patient at significant risk, the team first implanted a dual-chamber leadless pacemaker system and subsequently removed the infected conventional pacemaker. Leadless pacemakers are advanced, capsule-sized devices that are implanted directly inside the heart through a minimally invasive procedure. Unlike traditional pacemakers, they do not require leads or a surgical pocket under the skin, significantly reducing the chances of infection and other complications.
During the procedure, two leadless pacemaker capsules were successfully implanted, one in the right atrium and another in the right ventricle, to restore complete pacing support. Once the new system was confirmed to be functioning optimally, the infected pacemaker generator and leads were carefully removed from the chest area. The infected tissue was thoroughly cleaned and treated before the wound was closed.
The procedure was performed under local anaesthesia, enabling the patient to remain conscious and communicate throughout the intervention. Following the successful procedure, the patient was shifted to the ICU for observation and demonstrated a smooth recovery. He was comfortable, ambulatory, and discharged in a stable condition.
About the case, (Prof.) Dr. Rabindra Nath Chakraborty, shared, “This was an extremely challenging case as the patient was completely dependent on his pacemaker, while the existing device had developed a severe infection. A conventional approach of replacing the device on the opposite side also carried the risk of recurrence. The leadless pacemaker provided the safest and most effective solution, eliminating the need for leads and a skin pocket, and helped us successfully restore his heart rhythm with minimal infection risk.”
The patient will continue follow-up care to monitor wound healing. The leadless pacemaker implantation site, accessed through a small puncture in the groin, requires no stitches and minimal post-procedure care.
The successful intervention highlights the growing role of advanced cardiac technologies in managing complex heart rhythm disorders and offering effective treatment options for high-risk patients with pacemaker-related complications.