Manipal Hospital Kolkata Treats Complex Pacemaker Infection Using Leadless Dual-Chamber Device

A 70-year-old Bihar resident with complete heart block and a serious pacemaker-related infection has been successfully treated through an innovative dual-chamber leadless pacemaker implantation at Manipal Hospital Salt Lake in Kolkata.

Prof. Dr. Rabindra Nath Chakraborty, Senior Consultant in Interventional Cardiology and Head of the Department of Cardiovascular Services at Manipal Hospitals Kolkata, led the complex intervention.

The patient had initially presented with complete heart block, experiencing repeated fainting episodes and a dangerously slow heart rate. Following diagnosis, physicians implanted an MRI-compatible dual-chamber pacemaker. Testing revealed that the patient's natural cardiac electrical conduction system had ceased functioning entirely, making him fully dependent on the device for survival.

Within a fortnight of the initial implantation, a severe infection developed at the pacemaker pocket beneath the patient's left collarbone. Despite receiving prolonged antibiotic therapy and specialized wound management across multiple medical centres in Bihar, Delhi, and Patna, the infection persisted. The situation deteriorated as the pacemaker device became exposed through the skin, creating a life-threatening scenario since the patient could not survive without pacing assistance.

Upon admission to Manipal Hospital Salt Lake, the clinical team devised a specialized strategy. Rather than simply removing the infected device—a potentially fatal approach given the patient's complete pacemaker dependency—they opted to first implant a new dual-chamber leadless pacemaker system before extracting the compromised conventional device.

Leadless pacemakers represent a significant advancement in cardiac technology. These capsule-shaped devices are positioned directly within the heart via a minimally invasive procedure. Unlike conventional pacemakers, they eliminate the need for leads or an implantation pocket beneath the skin, substantially reducing infection risk and other associated complications.

The surgical team successfully implanted two leadless pacemaker capsules—one positioned in the right atrium and the second in the right ventricle—to provide comprehensive pacing support. After confirming optimal function of the new system, the medical team carefully removed the infected pacemaker generator and associated leads from the chest cavity. The affected tissue underwent thorough cleaning and treatment before closure.

The procedure was performed under local anaesthesia, permitting the patient to remain awake and communicate throughout the intervention. Following the successful operation, the patient was admitted to the intensive care unit for monitoring and subsequently demonstrated an uncomplicated recovery. He regained mobility, felt comfortable, and was discharged in stable condition.

Prof. Dr. Chakraborty commented on the case: "This presented an extraordinarily difficult scenario because the patient was entirely reliant on his pacemaker while simultaneously battling a life-threatening infection in the existing device. Standard replacement procedures on the opposite side carried the danger of infection recurrence. The leadless pacemaker represented the optimal and most secure solution, negating the requirement for leads and a skin pocket, and enabling us to restore normal heart rhythm while minimizing infection risk."

The patient will undergo continued follow-up appointments to assess wound healing progress. The leadless pacemaker access point through a small groin puncture requires no sutures and demands minimal post-operative care.

This case underscores the expanding significance of cutting-edge cardiac technologies in addressing intricate heart rhythm disturbances and furnishing viable solutions for critically ill patients experiencing pacemaker-related difficulties.