Leadless pacemaker implantation through the right internal jugular vein: primary results from the VAMPIRE prospective registry

Background/Introduction The right internal jugular (RIJ) vein represents an alternative access route for leadless pacemaker (LP) implantation (1). This approach may improve procedural safety compared with the conventional femoral route and facilitate early mobilisation, potentially enabling same-day discharge. However, clinical data on this access are limited, and its adoption in clinical practice remains at an early stage. Purpose To evaluate the feasibility and safety of LP implantation via the RIJ vein and to assess the feasibility of same-day discharge following this approach during an early multicentre experience. Methods This prospective, multicentre registry enrolled consecutive patients with an indication for LP implantation and a planned first-line RIJ venous access. All operators had extensive experience with femoral access but no prior experience with the RIJ approach. Procedural success, defined as successful device implantation through the RIJ vein, and periprocedural complications were systematically collected. In eligible patients, feasibility and safety of same-day discharge were assessed according to predefined criteria, including procedural success, absence of access-site complications, and no readmissions during the first month. Results From May 2024 to November 2025, 193 patients (61% male, mean age 77 ± 11 years) were included. Eighty-six percent were receiving antiplatelet or anticoagulant therapy. An attempt at RIJ implantation was performed in 176 patients (91%). The main contraindications to RIJ access were unsuitable venous or neck anatomy (11 patients) and the presence of a pre-existing RIJ catheter (6 patients). Procedural success rate was 98% (172/176). Implantation failure was attributed to RIJ thrombosis in two patients and unsuccessful advancement of the LP sheath in two patients. Postoperative superficial bleeding occurred in 3/176 (1.7%) and haematoma in 4/176 (2.3%), all resolving spontaneously without further intervention. Sixty-four patients were eligible for same-day discharge and were discharged on the same day, with no complication or readmissions. Conclusions In this early multicentre experience, LP implantation through the RIJ vein was proved feasible and safe in the majority of eligible patients, despite operators having no previous experience with this approach. The procedure was associated with a low rate of vascular complications and enabled same-day discharge in selected cases, supporting its potential role in future ambulatory cardiac pacing strategies. The RIJ route may emerge as a first-line option for upcoming generations of leadless pacemakers (2).