Jugular implantation of an active fixation leadless right ventricular pacemaker
T Brix, E Von Felten, F Lugano, A Breitenstein, A Mueller, C Wiederkehr, D HoferAbstract
Aims
Leadless pacemaker therapy eliminates lead- and pocket-related complications inherent to conventional transvenous systems. While femoral venous access remains the standard approach, it is associated with significant inguinal-site morbidity including vascular complications, hematomas, and prolonged patient discomfort. The jugular vein (JV) approach has been studied and described as a safe alternative for passive fixation leadless pacemakers. This study evaluated the implantation of an active fixation leadless pacemaker (AVEIRTM VR, Abbott) using a JV access and compared it to implantation using a femoral vein (FV) access.
Methods and Results
Consecutive leadless pacemaker implantations from a single tertiary cardiac center throughout the same time period were prospectively included and analyzed for safety, efficacy, and electrical parameters (13 JVA, 14 FVA). Median procedure time did not significantly differ (30 min JVA, 24min FVA, p=0.19). Median fluoroscopy time was longer in the JV group (6.2 min JVA, 2.5min FVA, p=0.019). Only one complication occurred in the JVA group (transient asystole during implantation, managed successfully). Device parameters (threshold, sensing, impedance) did not significantly differ between groups.
Conclusion
The jugular approach represents a safe and efficient alternative to femoral vein access for leadless pacemaker implantation with an active fixation when performed by experienced operators. However, fluoroscopy time may be longer, especially during the learning curve.