In a rare feat performed at Indira Gandhi Medical College (IGMC), Shimla, the Cardiology department removed three fractured leads of a pacemaker from the heart through a non-surgical procedure.
Seventy-year-old patient, Sanjeev Gupta, from Solan was thus saved from undergoing open heart surgery by a team of doctors headed by cardiology department, Prof Rajeev Bhardwaj.
Bhardwaj said that Gupta was implanted dual chamber (one lead in right atrium and one in right ventricle) permanent pacemaker in January 2014 for an episode of unconsciousness, diagnosed as a heart block.
He was doing well, however, after three years he again complained of an episode of unconsciousness and fracture of a lead of the pacemaker in his ventricle was discovered, said Bhardwaj.
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.
He was implanted permanent pacemaker on 17 April from left subclavian vein approach, as the right had already blocked.
The patient is recovering and will be discharged by 24 April, he added.
Bhardwaj was assisted by Dr Rajesh Sharma (Assistant Professor) and senior residents Dr Sachi Sandhu, Dr Ashu Gupta and Dr Sabina from Cardiac Anaesthesia.