A block in both the veins in the chest to insert a wire (pacemaker leads) for pacemaker implantation in the heart did not deter this doctor from adapting to a whole new treatment modality– leadless pacemaker implant, thereby avoiding an open heart surgery. This decision was taken by Dr. Sunil Gouniyal, Consultant Cardiologist – MMI Narayana Multispeciality Hospital considering the age and health condition of the patient as well as his medical history.
Ramesh (name changed) – a 75 year old man with previous history of heart problem was diagnosed with a condition called complete heart block – a case where electrical system of heart does not work the right way. This can cause a person’s heart to beat too slowly. Coupled with this he had dizziness, fatigue, fainting spells and breathing difficulty. This is a critical heart problem that required immediate evaluation and treatment.
During examination, doctors at MMI Narayana Multispeciality Hospital found that the patient required a pacemaker implantation to normalize his heart beat, but both his veins were blocked. Pacemaker traditionally requires a vein to insert the wire (leads) leading to the heart chambers and the battery of the pacemaker is placed under the skin near the collar bone. However, since both the veins in the chest were blocked for this patient, doctors had to plan a different treatment modality for him as he wasn’t in a condition to undergo an open heart surgery that would cause a high risk. He had already undergone two major surgeries earlier at a different hospital – one for heart and the other for neck.
Dr. Sunil Gouniyal used a technique for the first time in Central India called ‘leadless pacemaker implant’. This is the latest intervention technique approved by FDA in April 2016. “It is considered one of the wonders in medical technology and even termed as a Science fiction”, said Dr. Gouniyal. Only around 15 to 20 cases have been done till date in the entire country using this technique, which is safe and lasts long. This implant comes without wire and does not require surgical pocket. It is a small device (less than one-tenth the size of traditional pacemakers and weighs only 2g) delivered through catheter via leg veins (femoral) and implanted directly into heart. The patient is discharged the next day without any complications. In the traditional method of pacemaker implantation there is a risk of infection, blood collection at the site of battery pocket insertion, lead malfunction and so on, which is not the case with leadless pacemakers. However, as pointed out by Dr. Gouniyal, currently the leadless pacemaker available in the market is equivalent to a single chamber pacemaker. With advancements in leadless pacemakers, doctors feel that this will change the whole scenario of pacing therapy in the future.
Cost is another factor and as more number of patients get the benefit of leadless pacemakers, the cost will also come down to make it affordable to more number of people.