Key result
Leadless pacemaker implantation via left internal jugular vein succeeds in mirror-image dextrocardia with absent IVC.
Why the study?
Mirror-image dextrocardia combined with absence of the hepatic segment of the IVC and azygos continuation significantly increases the technical complexity of leadless pacemaker implantation.
This case demonstrates the feasibility and safety of implanting a leadless pacemaker via the left internal jugular vein using image mirroring technology in a patient with complex dual anatomical variations (mirror-image dextrocardia and absent IVC hepatic segment).
May offer alternative access for leadless pacemakers when femoral routes are precluded by rare anomalies; leaves open need for prospective validation.
Mirror-image dextrocardia combined with absence of the hepatic segment of the inferior vena cava (IVC) and continuation of the azygos vein represents an extremely rare dual anatomical variation that significantly increases the technical complexity of leadless pacemaker (LP) implantation. This paper presents a 28-year-old male patient who required permanent pacing therapy due to third-degree atrioventricular block. Preoperative computed tomography angiography (CTA) clearly identified the aforementioned malformations. A Micra AV leadless pacemaker was subsequently implanted successfully via the left internal jugular vein. During the procedure, image mirroring technology was employed to assist the operation, ensuring precise deployment and stable parameters. This case marks the world's first successful LP implantation via the internal jugular vein in a patient with such complex anatomical variations, offering a novel, safe, and feasible approach for similar patients.
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Bao et al. (2026) studied this question. Successful implantation of a leadless pacemaker via the left internal jugular vein was achieved in a patient with mirror-image dextrocardia and absence of the IVC's hepatic segment.
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