In a major breakthrough in cardiac electrophysiology, doctors at Indraprastha Apollo Hospitals have successfully implanted a leadless pacemaker through a metallic prosthetic tricuspid valve in a 65-year-old patient — a first-of-its-kind procedure in India.
The complex intervention was led by Dr Vanita Arora, Clinical Lead – Cardiac Electrophysiology. The patient had a long medical history, including previous cardiac surgery and a tricuspid valve replacement with a mechanical prosthetic valve in 2018. Recently, he developed dizziness and near-fainting episodes. Tests confirmed sinus node dysfunction and atrioventricular conduction disease, requiring permanent pacemaker support.
Conventional pacemaker implantation was not possible because leads cannot safely pass through a mechanical tricuspid valve, as it may damage the prosthesis and cause complications. Another open-heart surgery to place epicardial leads was also considered high risk due to the patient’s multiple prior procedures.
To address the challenge, the cardiac electrophysiology team opted for a leadless pacemaker system. Unlike traditional devices, the leadless pacemaker is a small self-contained unit delivered directly into the heart through a catheter inserted via a vein in the leg, eliminating the need for pacing leads.
During the procedure, a dual-chamber Aveir leadless pacemaker was implanted in the right ventricle. The team carefully navigated across the mechanical valve and positioned the device to maintain atrioventricular synchrony while preserving the function of the prosthetic valve.
“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,” said Dr Arora.
The patient recovered well after the procedure and was discharged in stable condition. Experts say the milestone highlights the growing potential of leadless pacing technology in treating complex cardiac cases, particularly for patients with prosthetic tricuspid valves who previously had limited treatment options.
Established in 1996, Indraprastha Apollo Hospitals is one of India’s leading tertiary care centres and the country’s first hospital to receive JCI accreditation.
(Photo courtesy: commons.wikimedia/Irshaaadk)