India, March 11 -- The world of cardiac care saw a notable development recently, when Dr Vanita Arora performed India's first implantation of a leadless pacemaker through a metallic prosthetic tricuspid valve at Indraprastha Apollo Hospital. The procedure, carried out on March 6, was performed on a 65-year-old male patient with a complex surgical and cardiac history who developed symptomatic bradyarrhythmia, a condition marked by an abnormally slow heart rhythm that can cause dizziness, fatigue and fainting. Dr Arora is currently the only doctor in the country to have carried out this technically demanding procedure. The patient's medical history goes back nearly three decades. In 1998, he underwent pancreaticojejunostomy, a procedure used to treat certain pancreatic conditions. Later, he developed fungal infective endocarditis affecting the tricuspid valve, a serious infection of the heart valve. In 2000, the patient underwent cardiac surgery in which the tricuspid valve was surgically debrided to remove infected tissue. Over time, he developed severe free tricuspid regurgitation, a condition in which the valve fails to close properly and blood flows backwards, eventually leading to symptoms of right-sided heart failure. As the condition progressed, he required another major cardiac intervention. In 2018, the tricuspid valve was replaced with a metallic bileaflet mechanical prosthesis (Artivion On-X, 31 mm). While the procedure improved valve function, the presence of a mechanical prosthetic valve created limitations for future cardiac procedures. Nearly eight years later, the patient began experiencing dizziness and presyncope caused by sinus node dysfunction and atrioventricular (AV) conduction disease, conditions that disrupt the heart's natural electrical rhythm. Doctors determined that permanent pacemaker implantation was necessary to restore a stable heart rhythm and prevent potentially dangerous complications. In this case, that approach was not feasible because passing pacing leads through a mechanical tricuspid valve prosthesis carries significant risks. Such leads can interfere with valve function, increase the risk of prosthetic valve thrombosis, or cause structural damage due to constant contact with the mechanical valve. An alternative option, epicardial pacing, which involves attaching pacing leads to the outer surface of the heart through surgery, would have required a third cardiac surgery for the patient, posing a significantly high risk. Additionally, epicardial leads typically have higher pacing thresholds, which can lead to rapid pacemaker battery depletion, often within two to three years This procedure marks the first time in India that a leadless pacemaker has been implanted through a metallic prosthetic valve, representing a significant milestone in cardiac electrophysiology. The successful implantation provided effective ventricular pacing and immediate symptom relief, while avoiding the limitations and risks associated with both transvenous and surgical epicardial pacing methods. htc...