Kolkata : In a landmark cardiac procedure, BM Birla Heart Hospital has successfully retrieved a leadless pacemaker that had been implanted for more than seven years and eight months — the first such documented case in Southeast Asia, including India.
The complex procedure was performed by Anil Mishra, Director of Cardiology at the hospital, marking a significant advancement in long-term leadless device management.
A High-Risk Retrieval After Years in Situ
The elderly patient had a long and complicated cardiac history, including prior coronary interventions and bypass surgery. In 2018, a conventional pacemaker system had to be removed due to recurrent infection. During the same hospital admission, a leadless pacemaker was implanted in the low right ventricular septum to manage symptomatic bradyarrhythmia.
The device functioned effectively for over seven years. However, in January 2026, it reached its Elective Replacement Indicator (ERI) — signaling battery depletion and the need for renewed pacing support.
While early retrieval of leadless pacemakers has occasionally been reported, extraction after prolonged implantation presents significantly higher risks. Over time, such devices become embedded in fibrotic tissue and endothelialised along the ventricular wall. After years inside the heart, removal carries potential complications including perforation or embolisation.
Across Southeast Asia, most documented retrievals have involved devices implanted for periods ranging from a few days to two to four years. In India, there has been no prior documentation of successful extraction beyond the early post-implant period of about one week. In this case, the device had remained in place for more than seven years.
A Carefully Planned Strategy
The medical team faced a critical decision: leave the depleted device in place and implant an additional leadless pacemaker — a strategy sometimes adopted — or attempt removal.
Given the limited long-term data on multiple leadless devices within the right ventricle and concerns about potential mechanical interaction or interference, the team opted for retrieval.
The procedure was performed under temporary pacing support via the left subclavian route. The device was successfully extracted in a single attempt without complications. Subsequently, a new single-chamber VVIR leadless pacemaker was implanted in the low right ventricular septal region, achieving stable thresholds and excellent electrical parameters.
Post-procedure imaging confirmed proper positioning and optimal function. The patient has recovered well.
Expertise in Advanced Device Management
Reflecting on the case, Dr. Anil Mishra stated:
“Leadless pacemakers were designed to reduce many of the complications associated with transvenous systems, but their long-term management is still evolving. When a device has been in place for several years, fibrotic encapsulation makes retrieval uncertain and technically demanding. The key is preparation — understanding the degree of fixation, planning for potential complications and ensuring pacing backup at every stage.
In this instance, the patient’s co-morbidities and frailty made it important to avoid leaving multiple intracardiac devices unless absolutely necessary. The procedure required controlled traction, precise catheter manipulation and continuous haemodynamic monitoring. Cases like this underline the importance of experience in device management. They are not routine interventions and demand a coordinated team.”
BM Birla Heart Hospital has developed a dedicated electrophysiology and device management programme capable of handling complex rhythm disorders, advanced device implantation and high-risk extraction procedures.
The successful retrieval of a long-standing leadless pacemaker adds to the institution’s growing record of high-complexity cardiac rhythm interventions, positioning it among the leading centres for advanced cardiac care in the region.
