First dual-chamber leadless pacemaker implantation at Meitra United Heart Centre, Kasaragod: a regional milestone in an octogenarian with sick sinus syndrome: a case report

Abstract

Leadless pacemaker technology has advanced to enable dual-chamber atrioventricular synchronous pacing through implant-to-implant communication between two independent leadless devices. We report the first AVEIR dual-chamber leadless pacemaker implantation performed at Meitra United Heart Centre (MUHC), marking a regional milestone for Kasaragod, Kannur, Coastal Karnataka, and Goa. An 86-year-old woman presented with sick sinus syndrome complicated by tachy-brady syndrome and presyncopal episodes. She underwent successful implantation of a dual-chamber leadless pacemaker via femoral venous access under general anesthesia using the Innvolution Pinnacle Agile Cath Lab at MUHC. Optimal electrical parameters were achieved, with a right ventricular threshold of 0.5 V at 0.4 ms and impedance of 750 Ω, and a right atrial threshold of 1.0 V at 0.4 ms and impedance of 310 Ω. Device-to-device communication was 100%. Postoperatively, the patient developed left femoral vein thrombosis, which was managed with anticoagulation therapy, and she was discharged in stable condition. This case demonstrates that dual-chamber leadless pacing is feasible in an octogenarian with sick sinus syndrome and may serve as an alternative to conventional transvenous pacing systems, while emphasizing the need to consider vascular access complications such as femoral vein thrombosis during patient selection.