Kolkata | February 2026: In a landmark achievement for global cardiac electrophysiology, CK Birla Hospitals – BM Birla Heart Hospital has successfully performed the world’s first documented extraction of a leadless pacemaker implanted for over seven years, followed by implantation of a new-generation Aveir VR leadless pacemaker.
The pioneering procedure was led by Dr. Anil Mishra, Director of Cardiology at the hospital, marking a path-breaking global milestone in advanced device management. The achievement is also the first of its kind in Southeast Asia, including India, further cementing the hospital’s leadership in managing highly complex cardiac rhythm interventions.
A Complex Clinical Challenge
The elderly patient had a long and complicated cardiac history, including prior coronary interventions and bypass surgery. In 2018, he required pacemaker support for symptomatic bradyarrhythmia. A conventional transvenous pacemaker system implanted earlier had to be removed due to recurrent infection. During the same admission, a leadless pacemaker was implanted in the low right ventricular septum, where it functioned reliably for over seven years.
In January 2026, the device reached its Elective Replacement Indicator (ERI), signalling battery depletion and the need for renewed pacing support.
While retrieval of leadless pacemakers shortly after implantation has been documented in limited instances globally, extraction after prolonged implantation presents a significantly higher level of complexity. Over time, such devices become embedded within fibrotic tissue and endothelialised along the ventricular wall. After several years in situ, detachment carries procedural risks including myocardial perforation or embolisation.
Across Southeast Asia, reported retrievals have typically involved devices implanted for only 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 approximately one week. In this case, the device had remained implanted for more than seven years — making the procedure unprecedented.
Strategic Clinical Decision-Making
The cardiac team faced a critical decision: leave the depleted device in place and implant an additional leadless pacemaker — an approach sometimes adopted — or attempt removal.
Given limited long-term data on multiple intracardiac leadless devices and concerns regarding potential mechanical interaction, interference, and patient frailty, the team opted for retrieval.
Under temporary pacing support via the left subclavian route, the device was extracted successfully in a single attempt without complication. A new single-chamber VVIR leadless pacemaker was subsequently implanted in the low right ventricular septal region, demonstrating stable pacing thresholds and excellent electrical parameters.
Post-procedure imaging confirmed satisfactory positioning and optimal device function. The patient has recovered well.
Expert Perspective
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. These are not routine interventions — they demand a coordinated and experienced team.”
Advancing Cardiac Device Management
BM Birla Heart Hospital has developed a dedicated electrophysiology and device management programme capable of handling complex rhythm disorders, advanced device implantation, and challenging extraction procedures. This latest success adds to the hospital’s expanding portfolio of high-complexity cardiac rhythm interventions and positions it at the forefront of advanced pacemaker management globally.
