Pisa Team Removes 27-Year-Old Infected Heart Lead in Minimally Invasive Procedure

A multidisciplinary team in Pisa has successfully removed a deeply embedded, infected cardiac pacing system from a 27-year-old woman and replaced it with a leadless dual-chamber pacemaker. The roughly six-hour, minimally invasive procedure gave her a curative treatment option after other centres considered surgery too risky and continuous antibiotics had been used as a temporary, palliative strategy.

The woman, who has Down syndrome and a congenital heart condition, received her first pacemaker at three months old. In late 2025, the system developed a serious Pseudomonas aeruginosa infection. Its principal lead was especially difficult to extract: implanted for 27 years, previously cut and firmly incorporated into tissue and blood vessels. Her respiratory and anaesthetic risks added to the challenge.

After specialists in cardiology, cardiac surgery and anaesthesia reviewed the case, they chose a fully minimally invasive strategy rather than conventional heart surgery. Using the locally developed “Pisa Approach,” clinicians passed mechanical dilators through the jugular vein to free and remove the old lead. They then implanted the new wireless device through the same access route and removed a second device. The patient awoke without complications, had a regular postoperative course and returned to her original centre to complete antibiotic treatment.