In a significant advancement in cardiac care, specialists at Indraprastha Apollo Hospitals successfully performed a complex leadless pacemaker implantation in a 65-year-old patient with a metallic prosthetic tricuspid valve. Led by Dr Vanita Arora, the team achieved a first-of-its-kind milestone in India by implanting a leadless pacemaker through a metallic prosthetic valve. This breakthrough offers a safer, minimally invasive treatment option for patients with similarly complex cardiac histories.
A Long and Complex Medical History
As per the press release, the patient had experienced a prolonged and challenging medical journey. In 1998, surgeons performed a pancreaticojejunostomy—a procedure that connects the pancreas to the jejunum to facilitate the drainage of pancreatic enzymes. However, he later developed fungal infective endocarditis that affected the tricuspid valve.
Consequently, in 2000 he underwent cardiac surgery for tricuspid valve debridement. Over time, his condition progressed to severe tricuspid regurgitation, which resulted in symptoms of right-sided heart failure. Eventually, in 2018, doctors replaced the damaged valve with a 31 mm metallic bileaflet mechanical prosthesis (Artivion On-X valve).
Emergence of New Cardiac Symptoms
Recently, the patient began experiencing dizziness and recurrent presyncope episodes. After careful evaluation, doctors diagnosed symptomatic sinus node dysfunction along with atrioventricular conduction disease. As a result, the medical team recommended permanent pacemaker implantation to restore normal heart rhythm.
Challenges With Conventional Pacemaker Implantation
However, conventional pacemaker implantation posed a major challenge. Typically, doctors place pacing leads through veins into the heart. In this case, passing leads through a mechanical tricuspid valve could damage the prosthetic valve and increase the risk of valve dysfunction, thrombosis, or lead failure.
Furthermore, repeat open-heart surgery to implant epicardial leads carried significant risks because the patient had already undergone multiple cardiac procedures.
Choosing an Innovative Leadless Pacing Approach
Given these limitations, the cardiac electrophysiology team led by Dr Vanita Arora opted for a leadless pacing system. Unlike traditional pacemakers, a leadless pacemaker is a compact, self-contained device delivered directly into the heart through a catheter inserted via a vein in the leg.
This technique eliminates the need for pacing leads and prevents interference with the prosthetic valve, making it particularly suitable for complex cases such as this one.
Implantation of a Dual-Chamber Leadless Pacemaker
During the procedure, the team implanted a dual-chamber Aveir leadless pacemaker designed to maintain atrioventricular synchrony. The procedure required meticulous planning and precise execution. Doctors carefully mapped the patient’s cardiac anatomy, navigated safely across the mechanical valve, and accurately fixed the device within the right ventricle.
Ultimately, the implantation successfully restored the patient’s heart rhythm while preserving the function of the prosthetic valve.
Expert Perspective on the Breakthrough
Commenting on the achievement, 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.”
Successful Recovery and Future Implications
Following the procedure, the patient recovered well and was discharged in stable condition. This pioneering intervention highlights the growing potential of advanced electrophysiology techniques in managing complex cardiac cases.
Moreover, the success of this procedure opens new possibilities for patients with prosthetic tricuspid valves who previously had limited treatment options. As leadless pacing technology continues to evolve, it may significantly expand safer and less invasive treatment pathways for high-risk cardiac patients across India.