Internal Jugular Vein as an Alternative Access for Pacemaker Implantation: A Mostly Left IJ Case Series

Leadless pacemakers traditionally rely on femoral venous access, which may be limited in patients with unfavorable IVC anatomy, prior interventions, or situations where preserving femoral access is preferred. Internal jugular (IJ) access offers an alternative route, but real-world data on IJ implantation of single- and dual-chamber leadless devices remain limited.

To describe patient characteristics, procedural details, and outcomes of pacemaker implantation via IJ access.

We performed a retrospective case series of five patients who underwent Abbott Aveir leadless pacemaker implantation-ventricular (VR), atrial (AR), or dual-chamber-via right and left IJ access at a single center. Demographics, indications, rationale for IJ access, procedural course, and acute device parameters were reviewed. Outcomes included procedural success, access-related complications, and device performance at discharge.

All five patients (mean age 41± 21 years; 40% female; BMI 25.9 ± 6.7 kg/m²) underwent successful IJ access implantation. Indications for pacemaker included intermittent complete heart block (n = 1), sinus node dysfunction (n = 4). Reasons for selecting IJ access included avoidance of femoral access in young active patients (n = 2), complex IVC anatomy with failed femoral advancement (n = 1), improved sheath control and trajectory for atrial leadless deployment (n = 1), and concern that patient could not tolerate post procedure precautions due to neurocognitive disorder. Acute device performance was favorable. VR devices demonstrated pacing thresholds 0.25-1.0 V @ 0.4 ms, R-wave amplitudes 8.9-17.9 mV, and impedance 410-910 Ω. AR devices showed thresholds 0.75-5.0 V @ 0.4 ms, P-wave amplitudes 0.5-4.4 mV, and impedance 320-910 Ω. Dual-chamber systems had stable parameters in both chambers. There were no intraprocedural or access-related complications, including no pneumothorax, hematoma, venous thrombosis, embolization, or hemodynamic instability. All patients had stable device function at discharge.

IJ vein access is a feasible and safe alternative for pacemaker implantation in patients with limited femoral access, including pediatric and complex adult populations. This approach allows effective device placement and stable pacing outcomes, avoiding femoral-related vascular complications. Further studies are needed to validate reproducibility and long-term performance.