In a rare and potentially life-threatening cardiac complication, doctors at Fortis Escorts Hospital, Faridabad successfully treated a 58-year-old man who developed a pacemaker pocket infection six months after implantation — an occurrence reported in roughly one out of 50 implant cases.

The patient had originally received a pacemaker after experiencing repeated episodes of unexplained unconsciousness over several years. While most pacemaker-related infections occur within the first month of implantation, the patient began showing signs of infection — including pus discharge from the pacemaker pocket — half a year later. The delayed onset raised immediate concern among doctors.

A series of investigations, including CT scan, ultrasound, pus culture and blood culture tests, confirmed a Cardiac Implantable Electronic Device (CIED) infection. What made the case particularly unusual was that the patient had been implanted with a newer wire-free system, which significantly reduces infection risk and makes such complications uncommon and more complex to manage.

The cardiology team, led by Sanjay Kumar, Senior Director, Cardiology, acted swiftly. Traditionally, management of such infections requires complete removal of the pacemaker, temporary pacing support for nearly two weeks, wound healing, and re-implantation of a new wired device on the opposite side of the chest. This approach often leaves patients immobilised and vulnerable to recurrent infections.

Instead, the Fortis team adopted a more advanced and patient-centric strategy. The infected device was safely removed, and the patient immediately underwent implantation of a next-generation dual-chamber leadless pacemaker. Unlike earlier leadless systems that could pace only one chamber of the heart, the new dual-chamber technology can synchronise both chambers, closely mimicking the heart’s natural rhythm.

The minimally invasive procedure was performed under local anaesthesia and completed within 60 to 90 minutes. As the system eliminates the need for chest pockets and pacing wires, it significantly reduces the risk of future infections.

“Pacemaker infections can be devastating if not addressed promptly,” said Dr. Kumar. “Earlier leadless pacemakers could pace only one heart chamber, which sometimes resulted in long-term complications such as breathlessness and progressive heart weakness. The new dual-chamber system ensures near-normal cardiac function, preserving heart strength and significantly improving quality of life.”

Following the procedure, the patient showed stable cardiac function with no recurrence of infection and was discharged in a stable condition with preserved left ventricular ejection fraction (LVEF) of 55–60%.

Amit Madaan, Senior Consultant, Cardiology, noted that while CIED infections are uncommon, they can escalate rapidly into severe systemic complications if not managed promptly. “Early diagnosis, timely device removal and immediate planning for advanced leadless pacing were critical in preventing sepsis and further cardiac compromise. The availability of dual-chamber leadless pacemaker technology has significantly transformed how we approach such complex cases,” he said.

Abhishek Sharma, Facility Director at the hospital, described the case as a reflection of the institution’s commitment to advanced, patient-centric cardiac care. He said the successful management of a high-risk pacemaker infection using cutting-edge technology highlights the hospital’s clinical expertise, infrastructure and multidisciplinary teamwork.

The case underscores how innovations in cardiac pacing are reshaping treatment pathways — offering patients safer alternatives, shorter hospital stays and improved long-term outcomes even in rare and high-risk scenarios.