Real-world experience with dual leadless pacemakers: a comparative study of jugular vs. femoral access for feasibility, safety, and electrical performance
F A Al-KandariAbstract
Objective
To compare procedural, electrical and demographic differences between jugular and femoral access routes for a dual-chamber Leadless Pacemaker (LP) System.
Methods
This prospective study compared jugular and femoral access for implantation of dual-chamber Leadless Pacemaker (LP) System, collecting data included demographics, indications, procedures, and electrical performance.
Results
Thirteen patients underwent leadless pacemaker (LP) implantation from June 2024 to June 2025. Four patients (2 female, mean age 77 years) received dual-chamber LP via jugular access, and nine patients (5 female, mean age 75 years) via femoral access. Atrioventricular block was the primary indication in both groups (4/4 jugular, 8/9 femoral), with isolated cases of bradycardia, atrial tachyarrhythmias, syncope, and sinus node disease. Final ventricular LP positions were in the right ventricular apical septum (jugular) and low-/mid-septum (femoral). Atrial LPs were placed in the right atrial lateral wall (jugular) and appendage (femoral). Mean procedure times for jugular access were 17±4 minutes (ventricular LP) and 20±3 minutes (atrial LP), with fluoroscopy times of 9±1 and 9±2 minutes, respectively. Femoral access times were 31±5 minutes (ventricular LP) and 27±5 minutes (atrial LP), with fluoroscopy times of 15±3 and 14±2 minutes. Electrical parameters were within acceptable ranges; jugular access demonstrated higher ventricular sensing and lower impedance. No procedure- or device-related complications were observed.
Conclusions
This first real-world comparison of jugular vs. femoral access for dual leadless pacemaker implantation suggests that jugular access may offer shorter procedure and fluoroscopy times with favorable electrical performance, while femoral access provides greater flexibility in device positioning.