Jugular versus femoral access for leadless pacemaker implantation: a propensity score–matched multicenter analysis
R De Lucia, A Nicosia, G Giannola, G Coppola, E Pisano', G Calvagna, V Giordano, C Mandurino, G Zucchelli, G ManzoAbstract
Background
Femoral access represents the standard approach for transcatheter leadless pacemaker implantation. However, superior venous access through the internal jugular vein has been increasingly adopted in selected centers. Comparative evidence adjusted for baseline clinical risk remains limited.
Purpose
To compare procedural characteristics and acute safety of jugular versus femoral access using propensity score matching in a prospective multicenter cohort.
Methods
Data were derived from a prospective One Hospital Clinical Service program including nine centers. The first 125 consecutive patients undergoing jugular leadless pacemaker implantation were propensity score–matched (1:1) with 125 femoral cases performed within the same centers. Matching variables included age, sex, prior cardiac implantable electronic device, atrial fibrillation, chronic obstructive pulmonary disease, and individual CHA2DS2-VASc components.
Results
The matched population (n=250) had a mean age of 76.1 ± 12.1 years and 72.0% were male. Prior device implantation was present in 10.4%, atrial fibrillation in 35.2%, advanced atrioventricular block in 26.8%, heart failure in 15.6%, and 38.0% had CHA2DS2-VASc ≥4. Single-chamber ventricular and atrioventricular sensing systems were implanted in 36.9% and 63.1%, respectively. Baseline characteristics were well balanced between groups. Procedural success was achieved in all patients. Procedure duration was longer with jugular access (45.8 ± 18.3 vs 37.6 ± 16.2 minutes; p<0.001), as was fluoroscopy time (8.5 ± 6.0 vs 7.4 ± 5.9 minutes; p=0.032). Conversely, time from procedure end to complete mobilization was significantly shorter in the jugular group (6.0 ± 7.7 vs 18.4 ± 6.5 hours; p<0.001). Device positioning differed between approaches (p=0.025), with a higher proportion of mid-septal implants via jugular access (75.2% vs 55.7%), whereas low septal positioning was more frequent in the femoral group (30.4% vs 18.4%). The number of device deployments (1.2 ± 0.5 vs 1.3 ± 0.7; p=0.245) and engaged fixation tines (2.7 ± 0.6 in both groups; p=0.729) were comparable. Acute electrical performance at implantation did not differ between groups. At least one acute periprocedural complication occurred in 0.4% (1/250), observed only in the femoral group (0.8% vs 0%; p=0.316), consisting of a pericardial effusion.
Conclusion
In this propensity score–matched multicenter analysis, jugular access demonstrated comparable acute safety to femoral access. Despite slightly longer procedural duration, the jugular approach enabled significantly earlier mobilization and facilitated mid-septal device positioning. These findings support jugular access as a safe and clinically efficient alternative strategy in experienced centers.