Bengaluru, Mar 16th: Aster RV Hospital has successfully performed a rare and first-of-its-kind leadless pacemaker implantation in Bengaluru, through the left jugular (neck) approach in an 85-year-old woman with complex medical challenges, marking a significant advancement in treating high-risk cardiac patients with limited procedural access.
The elderly patient was admitted with cellulitis (infection) in the right leg along with extensive post-burn contractures involving the groin and abdominal regions, resulting in tight skin and restricted vascular access. She presented with persistent giddiness, and ECG evaluation revealed a complete heart block, a life-threatening condition requiring urgent permanent pacing. Her family described her condition as a constant struggle, as she had gradually become weak, dependent, and anxious about her health.
Due to the ongoing infection and fragile skin condition, a conventional pacemaker posed a high risk of complications. The patient first underwent right-leg debridement to remove infected tissue and was temporarily supported with a pacemaker.
Given her ongoing infection and severely restricted groin access due to burn contractures, the cardiology team determined that a leadless pacemaker would be the safest option. However, the standard femoral route was not feasible, leaving the team to consider an unconventional but potentially life-saving approach through the left jugular vein in the neck.
The complex procedure was successfully performed under echocardiographic and fluoroscopic guidance by the cardiology team, including Dr Bharathraj, Electrophysiologist, and Dr G Dimpu Edwin Jonathan, Consultant Interventional Cardiologist, Aster RV Hospital.
Dr G Dimpu Edwin Jonathan said, “This was an extremely challenging case because the patient had active infection and severe post-burn skin contractures that made conventional pacemaker implantation unsafe. The leadless pacemaker provided a minimally invasive and infection-resistant solution. Choosing the left jugular route required careful planning and precision, but it allowed us to successfully deliver life-saving therapy.”
Leadless pacemakers are increasingly becoming the first choice in patients where infection risk is high or vascular access is limited. Although the neck approach can pose technical challenges during device deployment, with advanced imaging guidance and expertise, it can be performed safely and effectively.
Following the procedure, the patient showed steady recovery with stabilisation of heart rhythm and resolution of symptoms, allowing her to continue treatment for her infection and rehabilitation.
This successful outcome highlights the hospital’s commitment to delivering advanced, patient-centric cardiac care and its ability to manage complex clinical scenarios through innovative and customised treatment approaches.
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