Apollo Hospitals Delhi Implants Dual-Chamber Leadless Pacemaker After Treating Conventional Pacemaker Infection

A multidisciplinary team at Indraprastha Apollo Hospitals, New Delhi, led by Dr. Vanita Arora, Clinical Lead – Cardiac Electrophysiology, treated a 63-year-old woman from Jammu who developed a persistent infection after receiving a conventional dual-chamber pacemaker for complete heart block and episodes of syncope.

The team included Dr. Leena Mediratta, Microbiology & Infectious Diseases, who supported microbiological assessment and antimicrobial guidance; Dr. Praveen Sodhi, General and Laparoscopic Surgeon, who managed the infected pacemaker pocket and wound; and Dr. Subhash Wangnoo, Endocrinologist, who oversaw diabetes management and peri-procedural glucose control.

Following the earlier pacemaker implantation at another hospital, the surgical wound failed to heal and continued to discharge pus despite antibiotic treatment. A culture performed at the previous hospital grew Klebsiella. Her care was further complicated by poorly controlled diabetes and rheumatoid arthritis requiring steroid therapy, both of which can affect infection control and wound healing. She had also previously undergone a left-foot amputation due to diabetic gangrene.

After consulting Dr. Arora, the patient was admitted to Indraprastha Apollo Hospitals on 22 August 2026. The infected pacemaker generator and both transvenous leads were removed, and temporary pacing was established through the left femoral vein to maintain her heart rhythm. Cultures from the infected pacemaker pocket subsequently grew Acinetobacter and Enterobacter, helping guide further infection management.

Once the multidisciplinary team determined that the patient was ready for permanent pacing, the choice of device was carefully considered because of her previous pacemaker infection, diabetes and impaired wound healing.

On 24 August 2026, Dr. Arora implanted an Abbott AVEIR DR dual-chamber leadless pacemaker system through the right femoral vein. Unlike a conventional pacemaker, the system does not require a surgical pocket beneath the skin of the chest or leads passing through the veins into the heart.

Instead, the system uses two small devices placed directly inside the heart: one in the right atrium and the other in the right ventricle. The devices communicate wirelessly on a beat-to-beat basis, allowing them to coordinate the upper and lower chambers and provide dual-chamber pacing.

The patient was mobilised within six hours and discharged the following day. At discharge, the two devices were communicating appropriately and the pacing parameters were reported to be satisfactory.

By avoiding another chest pocket and transvenous leads, the leadless system provided an alternative for a patient at increased risk of recurrent device infection and poor wound healing. Leadless pacing is not suitable for everyone, and device selection depends on the patient’s rhythm disorder, anatomy, infection status, previous procedures and overall clinical condition.

The case highlights how multidisciplinary infection management, control of underlying medical conditions and individualised device selection can support the treatment of patients with complex cardiac pacing needs.