IGMC doctors remove broken pacemaker by rare non-surgical procedure

The doctors at Indira Gandhi Medical College (IGMC), Shimla have removed broken pacemaker by a rare non-surgical procedure to implant a permanent pacemaker.

A pacemaker is a small, battery-operated device. This device senses when your heart is beating irregularly or too slowly. It sends a signal to your heart that makes your heart beat at the correct pace.

Seventy-year-old patient, Sanjeev Gupta, from Solan had approached the medical college with fractured lead and was having three leads and was prone to unconsciousness, giddiness in absence of that. He was thus saved from undergoing open heart surgery by a team of doctors headed by cardiology department, Prof Rajeev Bhardwaj.

The patient had been implanted dual chamber (one lead in the right atrium and one in right ventricle) permanent pacemaker in January 2014 for an episode of unconsciousness, diagnosed as a heart block. After 3 years he again complained of an episode of unconsciousness and fracture of a lead of the pacemaker in his ventricle was discovered by the doctors.

In April 2016, Gupta was subjected to a new lead insertion as his old lead remained in his ventricle, he said, adding that this year again in April, it was found that the new lead too had fractured and with this, he had three leads in his heart.

He was required another lead insertion to prevent episodes of unconsciousness and possible sudden death as the right subclavian vein, through which leads had been inserted, was blocked.

The only option was to remove three leads with open heart surgery, which is a major surgical procedure. However, taking up the challenge, Bhardwaj decided to remove the leads, non- surgically through a procedure which is being carried out only in a few medical centres of the country.

On 13 April, the pocket of the pacemaker was opened to detach the leads with the help of locking device that was inserted through the leads and one by one the leads were pulled.

However, as the leads were firmly attached to the muscle of the heart and tissue around the vein, it could not be pulled, he added.

Ultimately, by adopting a difficult procedure by inserting a cutting device over the heads, slowly the tissues attached around the leads were cut.

As one of the leads got cut during pulling, Bhardwaj then pulled the end of this lead remaining inside the heart with the help of a snare, inserted through femoral vein so as to remove all the three leads.

During the procedure, the patient was put on a temporary pacemaker and the whole exercise took around four hours, said, Bhardwaj.

The patient was implanted permanent pacemaker on 17 April from left subclavian vein approach, as the right had already blocked, in a procedure that took almost 4 hours. The patient has been recovering and will be discharged soon.