New Delhi: In a major advancement in cardiac electrophysiology, specialists at Indraprastha Apollo Hospitals have successfully performed India’s first leadless pacemaker implantation through a metallic prosthetic tricuspid valve in a 65-year-old patient.
The complex procedure was carried out by Dr Vanita Arora, Clinical Lead – Cardiac Electrophysiology, offering a safer and minimally invasive solution for patients with complex cardiac histories who are not suitable for conventional pacemaker implantation.
Complex Cardiac History
The patient had a long and complicated medical history spanning more than two decades. In 1998, he underwent pancreaticojejunostomy, a surgical procedure connecting the pancreas to the jejunum to facilitate drainage of pancreatic enzymes.
Following this surgery, the patient developed fungal infective endocarditis affecting the tricuspid valve. In 2000, he required cardiac surgery involving debridement of the tricuspid valve.
Over the years, his condition progressed to severe tricuspid regurgitation, eventually causing symptoms of right-sided heart failure. In 2018, he underwent tricuspid valve replacement with a 31 mm metallic bileaflet mechanical prosthesis (Artivion On-X valve).
Need for Pacemaker but Limited Options
Recently, the patient began experiencing dizziness and presyncope episodes. Medical evaluation revealed symptomatic sinus node dysfunction along with atrioventricular conduction disease, making permanent pacemaker implantation necessary.
However, conventional pacemaker implantation was not possible because pacing leads cannot safely pass through a mechanical tricuspid valve. Doing so could damage the prosthetic valve and increase the risk of thrombosis, valve malfunction, or lead failure.
Repeat open-heart surgery to place epicardial pacing leads was also considered high-risk, as the patient had already undergone multiple major cardiac surgeries.
Leadless Pacemaker as a Safer Alternative
To overcome these challenges, the cardiac electrophysiology team opted for a leadless pacemaker system. Unlike traditional pacemakers that require leads inserted through veins into the heart, leadless pacemakers are self-contained miniature devices delivered directly into the heart via a catheter inserted through a vein in the leg.
In this case, doctors implanted a dual-chamber Aveir leadless pacemaker, capable of maintaining atrioventricular synchrony.
The procedure required:
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Detailed mapping of the heart
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Careful navigation across the mechanical valve
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Precise positioning and fixation of the device within the right ventricle
The successful implantation restored the patient’s normal heart rhythm while preserving the function of the prosthetic valve.
Expert Insight
Speaking about the case, Dr Vanita Arora said:
“Patients with mechanical tricuspid valves who require pacing present a unique challenge because conventional pacemaker leads cannot be passed across the valve. Leadless pacing technology allowed us to safely restore heart rhythm without repeat open-heart surgery, offering an important option for patients with complex surgical histories.”
The patient recovered well following the procedure and has been discharged in stable condition.
Expanding Possibilities in Cardiac Care
This landmark procedure highlights the growing role of leadless pacing technology in managing complex cardiac conditions. It also opens new treatment possibilities for patients with prosthetic tricuspid valves who previously had limited or high-risk options for pacemaker therapy.
About Indraprastha Apollo Hospitals
Established in 1996, Indraprastha Apollo Hospitals is one of India’s leading super-specialty healthcare institutions and the country’s first JCI-accredited hospital. The hospital operates over 700 beds, 19 operation theatres, and 138 ICU beds, offering advanced tertiary care across more than 57 specialties.
The hospital has been at the forefront of medical innovation in India, performing pioneering procedures including India’s first successful pediatric and adult liver transplants, while continuously adopting advanced diagnostic and therapeutic technologies.