Redefining access: the jugular approach for leadless pacemaker implantation

Introduction Leadless pacemakers have emerged as a valuable alternative to conventional transvenous pacing systems, particularly in patients with higher infectious risk, limited venous access or severe chronic renal disease. The femoral vein is the stablished traditional access, but the approach through internal jugular vein has been proposed as an alternative to simplify the device delivery, reduce procedural time and allow for earlier mobilization. However, data on the efficacy and safety of the jugular approach remain limited. Objective to evaluate the initial experience of leadless pacemaker implantation via right jugular access. Methods A retrospective cohort study including adult patients who underwent leadless pacemaker implantation through the jugular vein between January and October 2025 at a tertiary centre. Baseline clinical characteristics and procedural variables were collected. Univariate analysis, including chi-square and Mann–Whitney U were used in between-group comparisons (jugular vs. femoral access). A p-value < 0.05 was considered statistically significant. Results A total of 13 consecutive patients (mean age 80.7 ± 6.3 years; 38% female) underwent jugular leadless pacemaker implantation. The main indications were previous device infection (31%) and severe chronic kidney disease or dialysis (46%). The majority of the procedures were performed in outpatients (86%) and in patients with atrial fibrillation (77%). Implantation success was achieved in all patients. At implantation, mean sensing amplitude was 7.8 ± 2.5 mV, impedance 749 ± 142 Ω, and threshold 0.5 V (0.25–2.0). When compared with the femoral approach series of our centre (n=72), the jugular approach was associated with shorter fluoroscopy time (3.5 vs 5.4 min, p = 0.025), shorter total procedure time (51.7 ± 6.9 vs 59.3 ± 21.9 min, p = 0.045), and shorter hospitalization duration (p = 0.026). No major procedural complications were observed. Conclusion Leadless pacemaker implantation via jugular access is safe and feasible with high success and adequate electrical performance. Compared with the usual femoral approach, appeared to be associated with shorter fluoroscopy and procedure times, as well as reduced hospitalization length. Larger prospective studies are needed to confirm these observations.