Complications of Temporary Transvenous Cardiac Pacing by Access Site: A Systematic Review and Meta-Analysis

The femoral and internal jugular veins are the most commonly used access routes for TTVPM placement. Femoral access is associated with higher rates of infection and bleeding due to groin proximity, whereas jugular access may increase the risk of vascular injury or pneumothorax when performed without imaging guidance. Despite numerous observational studies comparing these access sites, the evidence remains inconclusive due to heterogeneous methodologies, small sample sizes, and varying definitions of complications. To address these limitations, we conducted a meta-analysis to compare the relative safety and effectiveness of jugular versus femoral access for TTVPM placement.

A comprehensive search of PubMed, Embase, and Cochrane was performed from June 28, 2025, without language restrictions. Eligible studies included adult patients (≥18 years) undergoing TTVPM placement and directly comparing femoral and jugular venous access. Trials were considered if they reported at least one of the following outcomes: bleeding, infection, lead repositioning, cardiac perforation, or other major procedural complications.

Six observational studies published between 2013 and 2024 met the inclusion criteria and encompassed 2,267 patients from diverse clinical settings. Bleeding complications were reported in five studies (n = 1,457), showing no statistically significant difference between access sites (RR 0.54; 95% CI 0.18-1.60; p = 0.27). Four studies (n = 528) reported catheter-related infections, demonstrating a significantly lower risk with jugular access (RR 0.25; 95% CI 0.11-0.53; p = 0.0003). Lead repositioning (RR 0.73; p = 0.46) and cardiac perforation (RR 0.50; p = 0.33) showed no significant differences.

Jugular venous access for TTVPM placement is associated with a significantly lower risk of catheter-related infections compared with femoral access, while rates of bleeding, lead repositioning, and cardiac perforation do not significantly differ between approaches. Jugular access may be preferred for patients expected to require prolonged pacing or those at high infection risk, whereas femoral access remains reasonable for short-term or emergent indications.