A heart care team at the PSG Hospital has placed a pacemaker in a 54-year-old woman’s leg to improve her heartbeat rate. The usual procedure is to place the pacemaker in the upper chest region or a little below the heart. But, the woman’s veins from the hands were so malformed that the hospital had to resort to the rare procedure of placing the pacemaker in her leg.

Medical Director of the hospital and cardiologist J.S. Bhuvaneshwaran told The Hindu that the team had to carry out an intensive search for earlier procedures elsewhere in the country or in the world to place the pacemaker in an alternative place.

“We found that the All India Institute of Medical Sciences in New Delhi had done two cases of permanent femoral (thigh) trans-veinous pacemaker. That gave us the encouragement and prospect of saving the woman,” Dr. Bhuvaneshwaran said.

The patient, E. Meenakshi of Selvapuram in the city, had come to the hospital three years ago with a heartbeat rate of 30-40 beats a minute instead of the normal 70 to 100. She fainted often because of this problem.

Dr. Bhuvaneshwaran and his team decided to provide a pacemaker for her. The pacemaker was normally placed in a pouch created by a cardio-thoracic surgeon in the upper chest (left or right) region. The lead (or wire) from the pacemaker was passed through the vein to the right ventricle (lower chamber) of the heart. The battery operated pacemaker sent electrical impulses through the lead to the heart and this kept the heart beating at the normal rate. Soon after the pacemaker was installed, the surgeons could programme the heartbeat rate.

But, in Meenakshi’s case, this was not possible because she had malformed veins from the right and left hands. So, her thorax was opened to create a pouch between the heart and the stomach in a procedure called trans-thoracic epicardial pace maker installation.

Dr. Bhuvaneshwaran said that though the procedure was successful, the battery was getting exhausted soon. She got the pacemaker replaced six months ago. The battery in this also lasted for only another six months and the episodes of fainting returned.

After finding that two femoral procedures had been done in the country, Dr. Bhuvaneshwaran, cardiologist Sajan Narayanan and cardio-thoracic surgeon E. Krishnan prepared to perform the rare procedure.

“Now, we had other problems to address though we found an alternative,” Dr. Bhuvaneshwaran said. “This procedure required a longer lead as it had to be passed through the vein from the thigh to the heart. The earlier firm that supplied the pacemaker did not have it. A Kolkatta-based company then offered to provide the pacemaker and a longer lead as it wanted to be a part of this rare procedure,” the cardiologist said.

“Meenakshi is fine. She has survived because of being a fighter. We are going to publish this procedure in the Indian Heart Journal. We want more heart centres to know of this procedure and save patients who cannot undergo the routine procedure because of malformed veins in the arms,” Dr. Bhuvaneshwaran said.