Simultaneous Leadless Pacemaker Implant With Atrioventricular Node Ablation via Internal Jugular Approach

INTRODUCTION: The feasibility and outcomes of simultaneous atrioventricular node ablation (AVNA) and leadless pacemaker (LLPM) implantation from the internal jugular (IJ) vein are not well studied. We report our single-center case series experience with concomitant implantation of the AVEIR LLPM and AVNA from the IJ venous approach. METHODS: Patients with persistent atrial fibrillation (AF) with frequent rapid ventricular rate (RVR) episodes refractory to pharmacological therapy and not ideal for AF ablation were selected for LLPM and AVNA. These procedures were performed simultaneously via the IJ vein due to patient preference and anatomical challenges (presence of severe scar tissue from prior procedures, presence of an inferior vena cava IVC filter, etc.). All patients were followed for at least 4 weeks post procedure. RESULTS: Ten patients (mean age of 76.1 ± 11.5 years, 60% female) underwent successful simultaneous AVEIR implantation and AVNA via IJ venous access. Median device implantation time was 15.5 min, procedure time was 45 min, fluoroscopy time was 6.4 min, and radiation dose was 82 mGy. No device repositioning occurred. Mean pacing capture threshold at implant was 0.65 ± 0.316 V and impedance of 848 ± 209 Ω. At follow-up, pacing capture threshold was 0.5 V at 0.4 ms in all patients. Mean radiofrequency (RF) time to successful AVN ablation was 191.6 ± 86 s. Hemostasis was obtained within 5 min in all cases. There were no procedure-related complications and no adverse interaction from performing these procedures simultaneously. Specifically, there was no interaction with radiofrequency current and LLPM function. Mean time to ambulation post procedure was 82 ± 12 min and six out of seven patients scheduled for an elective procedure were able to be discharged home the same day. CONCLUSION: This early series suggests that simultaneous AVNA and LLPM implantation from the IJ is feasible and safe. This IJ approach provides an alternative access option for the ablate and pace strategy and allows for early ambulation and discharge.