Association Between Inferior Vena Cava Location and the Number of Deployments of a Leadless Pacemaker

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Bradycardia requiring leadless pacemaker (n=96). Intervention: Left-sided inferior vena cava vs. Right-sided inferior vena cava. Primary outcome: Multiple deployments defined as the number of device deployments ≥ 2 (adjusted OR 9.5, 95% CI 1.5-58.7, p=0.02).

Q: What does this research mean for the field?

A left-sided inferior vena cava is associated with a significantly higher risk of requiring multiple deployments during leadless pacemaker implantation compared to a right-sided inferior vena cava. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Tomoya Kimura; Yusuke Yoshikawa; Mari Nezu; Fumihiro Sakakibara; T. Iseda; Takanari Fujita; Shuhei Tsuji; Satoshi Shizuta; Takeshi Morimoto

doi:10.1002/joa3.70431

July 19, 2026Journal of ArrhythmiaOpen Access

Association Between Inferior Vena Cava Location and the Number of Deployments of a Leadless Pacemaker

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Key result

Left-sided IVC is linked to 67% risk of multiple deployments during leadless pacemaker implantation.

adjusted OR 9.5
95% CI 1.5-58.7
P=0.02
n=96

Figures

Graphical abstract published by Journal of Arrhythmia — Graphical abstract · Published by Journal of Arrhythmia · CC BY-NC-ND

Why the study?

While some patients face difficulty during leadless pacemaker implantation, the relationship between inferior vena cava location and procedural difficulty remained uncertain.

Does left-sided IVC location increase the risk of multiple deployments during leadless pacemaker implantation in patients with bradycardia?

Key Points

To determine the relationship between inferior vena cava anatomical location and procedural difficulty during leadless pacemaker implantation.
Single-center cross-sectional study of 96 consecutive patients undergoing Micra leadless pacemaker implantation between July 2022 and November 2024.
Patients were categorized into right-sided (N=81) or left-sided (N=15) inferior vena cava (IVC) groups based on preprocedural computed tomography alignment with the right ventricular septum.
The primary endpoint was multiple device deployments, defined as two or more deployments during the implantation procedure.
Multiple deployments occurred in 67% of the left-sided IVC group versus 36% of the right-sided IVC group, yielding an adjusted odds ratio of 9.5 (95% CI: 1.5–58.7, p = 0.02).
Patients with left-sided IVC required a higher median number of deployments (2 vs. 1, p = 0.042) and had numerically longer procedure times (36 min vs. 25 min, p = 0.11).
Pericardial effusion occurred in two patients in the right-sided IVC group and zero in the left-sided group (neither requiring intervention), while 30-day procedural success was 93% versus 96%.

Study Design

Type

Cross-Sectional (n=96)

Multicenter

No

Structured PICO

Does left-sided IVC location increase the risk of multiple deployments during leadless pacemaker implantation in patients with bradycardia?

P

Population

96 consecutive patients (mean age 84, 43% female) with bradycardia who underwent implantation of Micra leadless pacemakers, evaluated for procedural difficulty.

E

Exposure

Left-sided inferior vena cava (IVC) location relative to the right ventricular septum as assessed by preprocedural computed tomography (n=15)

C

Comparator

Right-sided inferior vena cava (IVC) location relative to the right ventricular septum as assessed by preprocedural computed tomography (n=81)

O

Outcome

Multiple deployments defined as the number of device deployments ≥ 2

Main Result

Odds Ratio: 9.5 (95% CI 1.5–58.7)

Absolute Event Rate: 67% vs 36%

p-value: p=0.02

A left-sided inferior vena cava is independently associated with a higher risk of requiring multiple deployments during leadless pacemaker implantation, highlighting the utility of preprocedural CT.

Limitations

Retrospective single-center observational study with a small sample size, especially in the left-sided IVC group (n=15).
Multivariable model included a limited number of covariates, potentially causing overfitting and unstable effect estimates.
Cardiac CT would have been preferable for a more precise assessment of the IVC position compared to plain CT.
The number of deployments may be influenced by operator skill, experience, and the condition of the myocardium.
Retrospective single-center observational study with a small sample size
Limited number of covariates in the multivariable model
Use of plain CT instead of cardiac CT for IVC position assessment
Difficulty may vary depending on operator's skill and experience

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Implication

Preprocedural CT assessment of IVC anatomy should not yet alter leadless pacemaker implantation strategy; leaves open whether this association is clinically actionable.

Abstract

Introduction While some patients faced the difficulty to implant leadless pacemaker, the relationship between inferior vena cava (IVC) location and procedural difficulty was uncertain. Methods We conducted a single‐center, cross‐sectional study including 96 consecutive patients who underwent implantation of Micra leadless pacemakers between July 2022 and November 2024. Based on the positional relationship between the IVC and the right ventricular septum assessed by preprocedural computed tomography, patients were classified into right‐sided and left‐sided IVC groups. The primary outcome was multiple deployments defined as the number of device deployments ≥ 2. Results A total of 96 patients were analyzed, including 81 in the right‐sided and 15 in the left‐sided IVC group. The mean age was 84, and 55 (57%) were male patients. Multiple deployments were observed in 39 (41%) patients. The risk of the primary outcome was significantly higher in the left‐sided IVC group than in the right‐sided (67% vs. 36%), with an adjusted odds ratio of 9.5 (95% CI: 1.5–58.7, p = 0.02). Procedure time was numerically longer in the left‐sided group (36 vs. 25 min, p = 0.11). Pericardial effusion occurred only in two patients in the right‐sided group, none requiring intervention. Conclusions The left‐sided IVC was associated with multiple deployments of a leadless pacemaker and preoperative computed tomography was useful in assessing the procedural difficulty.

Discussion

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Cite This Study

Kimura et al. (2026) conducted a cross-sectional in Bradycardia requiring leadless pacemaker (n=96). Left-sided inferior vena cava vs. Right-sided inferior vena cava was evaluated on Multiple deployments defined as the number of device deployments ≥ 2 (adjusted OR 9.5, 95% CI 1.5-58.7, p=0.02). A left-sided inferior vena cava was associated with a higher risk of requiring multiple deployments during leadless pacemaker implantation compared to a right-sided IVC.

synapsesocial.com/papers/6a605d4a4163e025518d7521 https://doi.org/10.1002/joa3.70431

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Association Between Inferior Vena Cava Location and the Number of Deployments of a Leadless Pacemaker

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Association Between Inferior Vena Cava Location and the Number of Deployments of a Leadless Pacemaker

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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