Jugular Versus Femoral Venous Access for Leadless Pacemaker Implantation: A Systematic Review and Meta‐Analysis

BACKGROUND: Leadless pacemakers (LPMs) have been shown to reduce complications compared with conventional transvenous pacing. Transfemoral venous access (FA) is the standard implantation approach; however, the transjugular approach (JA) has recently emerged as an alternative strategy, but comparative evidence remains limited. Therefore, we perform a systematic review and meta-analysis comparing JA and FA for LPMs implantation in terms of electrical performance, procedural efficiency, and complications. METHODS: All studies comparing JA and FA for LPMs were systematically identified. Pooled analyses were performed for pacing threshold, sensed R-wave amplitude, impedance, total procedural time, fluoroscopy duration, and procedural complications. RESULTS: Three observational studies were included. No significant differences were observed between FA and JA in mean pacing threshold (MD 0.05 ms; 95% CI -0.03 to 0.12), mean sensed R-wave amplitude (MD 0.31 mV; 95% CI -0.51 to 1.14), or impedance (MD 45.79 Ω; 95% CI -27.03 to 118.61). Total procedural time was comparable between approaches (MD -0.44 min; 95% CI -8.47 to 7.60). JA was associated with a significant reduction in fluoroscopy time compared with FA (MD 2.73 min; 95% CI 0.66 to 4.81). JA also significantly reduced overall procedural complications (1.8% vs. 15%; OR 0.12, 95% CI 0.04 to 0.39) and wound care-related adverse events (0% vs. 14%; OR 0.07, 95% CI 0.01 to 0.36). No differences were observed in device dislodgement, pericardial effusion, or emergent device removal. CONCLUSIONS: JA provides comparable electrical performance to FA while reducing fluoroscopy exposure and access-related complications, supporting its use as a safe alternative for LPMs implantation.