Right jugular access as the primary approach for leadless pacemaker implantation in a center without cardiac surgery

Leadless pacemaker (LP) implantation via the right internal jugular vein (RIJV) may overcome limitations of the femoral approach, reducing vascular complications, and improving navigation across the tricuspid valve. This study aimed to explore the feasibility and safety of RIJV LP implantation in a center without cardiac surgery.

observational study of all patients undergoing RIJV LP implantation at an institution without cardiac surgery.

Between April 2024 and June 2025, leadless pacemaker implantation via the RIJV was attempted in 34 patients, with a success rate of 85.3 % (n = 29). Implantation failed in five patients due to venous occlusion/stenosis (n = 4) or cardiac tamponade (n = 1). Among successful cases, fluoroscopy and procedure times averaged 7.3 ± 4.9 and 34.9 ± 13.7 minutes, respectively. Most implants (75.8 %) required a single deployment and were placed in the mid-septal area. No major access-related complications occurred. A learning curve was evident, with significant reduction in procedure time across tertiles. No significant differences were found in deployment attempts or final device position among tertiles.

The right jugular approach is feasible and safe, potentially expanding LP implantation among centers without cardiac surgery, though vascular assessment is crucial for patient selection.