Comparative evaluation of internal jugular versus femoral approaches for leadless pacemaker implantation: a retrospective analysis

Background Leadless pacemakers have transformed cardiac pacing by eliminating transvenous leads. The internal jugular (IJ) approach is a novel technique for leadless pacemaker implantation and represents a feasible alternative to the traditional femoral approach, particularly in patients with unsuitable femoral access. Objective To compare procedural characteristics and pacing outcomes between internal jugular and femoral vein approaches for leadless pacemaker implantation. Methods We retrospectively reviewed consecutive patients who underwent MICRA leadless pacemaker implantation via the internal jugular or femoral vein between June 2024 and Nov 2025 (n=62). Demographics, vascular access details, radiation dose, fluoroscopy time and pacing parameters were recorded (Table 1). Device performance at the first routine follow-up was assessed in patients with successful implantation (n=61). Results Of 62 patients, 31 (50%) underwent via IJ vein and 31(50%) via the femoral vein (Table 2). Three patients required a change in access due to unfavourable venous anatomy (two from jugular to femoral and one from femoral to jugular). Successful implantation was achieved in 61 patients. Median fluoroscopy time was similar between groups (femoral 3.47 min vs. jugular 3.36 min, p=0.816). Median radiation dose was lower with the jugular approach (32 mGy vs 50 mGy, p=0.213). Median procedure time was 45 min for the femoral group and 40 min for jugular group. A low pacing threshold (PCT) was achieved in 90% of femoral and 97% of jugular implants. Follow-up data were available in in 50 patients; stable low PCTs were maintained in 88% of femoral and 96% of jugular cases. No significant access-site complications were observed. Conclusion Leadless pacemaker implantation via the internal jugular vein is safe and feasible. Compared with the femoral approach, it offers similar procedural efficiency, lower radiation exposure, and stable pacing parameters.