Related Experiment Video
Updated: Oct 17, 2026
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
First-in-Human Axillary Vein Implantation of a Leadless Pacemaker: Breaking the Access Barrier
Lydia Messele1, William Leon1, Niailah Ochai1
1Division of Cardiovascular Medicine, Department of Internal Medicine, University of California-Davis Health, Sacramento, California, USA.
Background:
Leadless pacemakers (LPs) are conventionally implanted transfemorally, with transjugular and subclavian routes reported as alternatives. Axillary access has not previously been reported.
Fih Summary:
A 78-year-old woman with chronic sacral wounds became temporary-pacing dependent following an inferior ST-segment elevation myocardial infarction. An LP was selected given infection risk. Because of a right femoral deep venous thrombosis, an abscess at the left femoral site, and restricted neck mobility limiting internal jugular access, she underwent left axillary vein implantation of an LP.
Discussion:
Axillary access served as a feasible alternative route. A septal position was achieved by rotating the delivery system counterclockwise, opposite the transfemoral direction, while a perpendicular sterile table supported the extracorporeal catheter length.
Novelty:
This is the first reported axillary vein implantation of an LP.
Take-Home Message:
Axillary venous access is a feasible bailout route for LP implantation when femoral and internal jugular access are unavailable.
