Leadless pacemaker therapy was introduced to overcome lead- and pocket-related complications in conventional transvenous pacemaker therapy. Implantation via the femoral vein, however, may not always be feasible. The aim of this study was to evaluate leadless pacemaker implantation using a jugular vein approach and compare it to the standard implantation approach through the femoral vein. The records of the first consecutive 100 patients undergoing MicraTM leadless pacemaker implantation via the right internal jugular vein from two centers were included in this study. Periprocedural safety and efficacy of the jugular approach were compared to the first 100 patients having undergone a femoral implantation approach at the University Hospital Zurich. 100 patients underwent successful implantation of a leadless pacemaker via the internal jugular vein (mean age, 81.18 ± 8.29, 60% males). Mean procedure time was 35.63 ± 10.29 min with a mean fluoroscopy time of 4.66 ± 5.16 min. The device was positioned at the inferior septum in 25 patients, at the high septum in 24 and mid-septum in 51 patients. The mean pacing threshold was 0.56 ± 0.35 V at 0.24 ms pulse width with a sensed amplitude of 10.0 ± 4.4 mV. At follow-up, electrical parameters remained stable in all patients. Compared with femoral implantation, patients undergoing jugular transvenous pacemaker implantation were of similar age and had similar comorbidities. Mean procedure- (48.9 ± 21.0 min) and fluoroscopy times (7.7 ± 7.8 minutes, both p <0.01) were shorter compared to the femoral approach. Electrical parameters were similar between the two approaches. There were only two complications during jugular veinous implantations (1 pericardial effusion and 1 dislocation), compared to 16 complications using the femoral approach (1 pericardial effusion, 2 femoral artery injuries and 13 major groin hematomas). The jugular approach may represent a safe and efficient alternative to the femoral implantation method for implantation of the Micra leadless pacemaker.