Transjugular implantation of a leadless pacemaker in a 97-year-old patient with severe kyphosis and tortuous femoral veins: a case report

Background Leadless pacemaker systems offer significant benefits for frail older adults by avoiding pocket- and lead-related complications. However, anatomical challenges including severe spinal deformities and significant venous tortuosity can complicate conventional transfemoral or trans-subclavian implantation. Case report A 97-year-old man with severe kyphosis, tortuous femoral veins, and high-grade atrioventricular block was referred for permanent pacing. Supine positioning for subclavian access was not feasible, and the femoral anatomy posed an unacceptably high procedural risk. Following a multidisciplinary assessment and procedural planning, a transjugular approach was selected. Implantation was performed with the patient in the left lateral decubitus position, using adapted fluoroscopic projections and temporary femoral pacing as backup. An Aveir ventricular response leadless pacemaker was successfully delivered via the right internal jugular vein. Final device parameters were satisfactory, with a sensing amplitude of 8.5 mV, a pacing threshold of 0.5 V at 0.4 ms, and an impedance of 510 Ω. No perioperative complications occurred. At follow-up, exertional dyspnea had resolved, and device performance remained stable. Conclusion This case demonstrates that transjugular implantation of a leadless pacemaker can be a safe and feasible alternative for older adults with complex anatomical limitations that contraindicate standard pacing approaches. Careful preprocedural assessment and adaptation of intraoperative techniques are essential for procedural success in high-risk settings.