Fortis Escorts Heart Institute, a pioneer and centre of excellence in cardiac care has conducted an unusual heart surgery by installing the pacemaker in the lower abdominal cavity of a 68-year-old woman for the second time.

Patient Naseema Begum is also a second time cancer survivor.

A pacemaker is a small device that is placed in the chest or upper abdomen to help control abnormal slow heart rhythms or arrhythmia. During an arrhythmia, the heart may not be able to pump enough blood to the body.

This can cause symptoms such as fatigue (tiredness), shortness of breath, or fainting. Severe arrhythmias can damage the body's vital organs and may even cause loss of consciousness or death.  The pacemaker uses electrical pulses to prompt the heart to beat at a normal rate.

In addition, the pulse generator attached to the pacemaker contains a small computer processor that can be programmed to set the rate of the pacemaker, the pattern of pacing, the energy output, and various other parameters. The pulse generator for most modern permanent pacemakers weighs one to two ounces.

This is one of the few such cases reported in India. The surgical team of doctors was headed by Dr Aparna Jaswal, senior consultant in the Department of Cardiac Pacing and Electrophysiology.

Naseema came to the doctors at FEHI two years ago, when she had her first pacemaker implanted in the right heart cavity while she was suffering from cancer of the left breast.

Subsequently, the cancer spread to the right breast and caused infection which trickled to the pacemaker installed in her right heart cavity. With a history of double mastectomy, doctors were presented with a unique challenge as there was no area in the chest or upper abdomen where the device could be re-implanted.

Dr Jaswal and her team performed the surgery of implanting the second pacemaker through a different route as opposed to the conventional one.

The new pacemaker was given an unusual location through the leg vein in the lower abdomen, also referred to as the retro peritoneal way.

Speaking on the procedure, Dr Jaswal said, “The patient, who is a two time cancer survivor has shown tremendous courage in surviving a series of illness. In this case, the patient had undergone cancer treatment and that compressed the area where implanting the device was more viable. So we had to take the retro peritoneal way. And therefore, we also had to import special leads to complete the surgery successfully.”

The family of the patient expressed their gratitude. “We are really grateful to Dr Aparna Jaswal and her team. She has reaffirmed our faith in doctors as we had very little hope of our mother’s survival. But Dr Jaswal has restored our happiness to our family,” said a family member of Naseema.