Leadless pacemaker implantation via the internal jugular vein a promising access for an established intervention

Abstract

Abstract Background Leadless pacemaker therapy was introduced in 2013 to overcome lead- and pocket-related complications in conventional transvenous pacemaker therapy. These leadless devices are self-contained right ventricular single-chamber pacemakers implanted via a femoral percutaneous approach. However, the femoral route is not always possible due to various reasons. The aim of this analysis is to share our first experience using a jugulary approach for the implantation procedure. Purpose To evaluate safety and feasibility of leadless pacemaker implantation via the internal jugulary vein. Methods The records of the first 34 patients who underwent leadless pacemaker implantation via the right internal jugular venous route at our center were analyzed prospectively. Follow-up period was 3 months. Safety as well as efficacy including electrical parameters of the jugular approach were compared with the data of the first 100 patients who underwent a femoral leadless pacemaker implantation at our center (implanted from 2015-2019). Results Thirty-four patients underwent internal jugular vein leadless pacemaker implantation (mean age, 82.37 ± 7.58, 58.8% males). All leadless pacemakers were implanted successfully. The jugular approach was well tolerated by all patients. Mean procedure time was 33.29 ± 8.81 min with a mean fluoroscopy time of 3.66 ± 2.07 min. The device was positioned at the inferior septum in 11 patients, at the high septum in two and midseptal in 21 patients. The mean pacing threshold was 0.52 ± 0.22 V at 0.24 ms pulse width with a sensed amplitude of 9.13 ± 4.08 mV. There were no complications during the procedure as well as during 3-month follow-up. At follow-up, electrical parameters remained stable in all patients. Conclusion Implantation of a leadless pacemaker via the right internal jugulary vein is a safe and effective alternative to the femoral approach.Patient demographics/device parameterDevice value development over time.