Comparison of transjugular and transfemoral approaches for leadless pacemaker implantation in Asian patients: an...

The transjugular approach has recently gained attention as a viable alternative for leadless pacemaker implantation. However, clinical data in Asian populations, who often present with smaller body size and vascular anatomy, remain limited. This study aimed to evaluate the safety and efficacy of the transjugular approach compared with the conventional transfemoral route in an Asian cohort.

We retrospectively analyzed 112 patients who underwent leadless pacemaker implantation between March 2021 and June 2025 at a single center. Patients were categorized by access route: transfemoral (n = 81) or transjugular (n = 31). Baseline characteristics, pacing parameters, and peri-procedural complications were compared between groups.

Baseline demographics and device indications were similar between groups. Procedural success, fluoroscopy time, and pacing performance were also comparable. However, puncture site bleeding complications occurred exclusively in the transfemoral group (14.8% vs. 0.0%, P = 0.035), and procedure-to-discharge time was significantly shorter in the transjugular group (1.4 ± 0.6 vs. 2.2 ± 1.4 days, P = 0.008). In multivariate analysis, female sex was identified as a significant independent predictor of procedure-related overall bleeding, while the transjugular approach was significantly protective (odds ratio 0.11, 95% confidence interval: 0.01-0.94, P = 0.043). No major bleeding events requiring surgical or endovascular intervention, device dislodgement, or procedure-related death occurred in the transjugular group.

The transjugular approach for leadless pacemaker implantation demonstrated comparable procedural efficacy and pacing performance, with significantly lower rates of both puncture site bleeding and overall complications, as well as shorter hospitalization. These findings support its use as a safe and effective alternative access route, particularly in Asian patients.