The jugular approach for leadless pacing: A novel and safe alternative

Abstract

Aims:To evaluate safety of leadless pacemaker implantation through the internal jugular vein in a larger cohort with longer follow-up. Moreover, feasibility of non-apical pacing as well as relation between pacing site and QRS duration were assessed.Methods: Eighty Two consecutive patients, who received a leadless pacemaker though the internal jugular vein, were included. Electrical parameters were measured at regular follow-up and any complications were registered. Paced QRS interval was compared for three pacing sites, RVOT, RV mid septum, and RV apical septum. Results:In all patients, the leadless pacemaker was implanted successfully. In 69 patients, the device was implanted in a non-apical position. In 71% of cases, the device could be deployed at first attempt. The median fluoroscopy time was 4.4 min (range 0.9−51) The paced QRS interval was significantly narrower for non-apical pacing sites compared to apical pacing si 156 vs. 179 ms. p = .04, respectively. During mean followup of 16 months (range 0-43 months), electrical parameters remained stable. Two complications occurred, which could be resolved during the implant procedure. There were no access site related complications. Conclusion:The jugular approach for leadless pacemaker implantation is feasible and may avoid vascular complications. It facilitates non-apical positioning of leadless pacemakers leading to a narrower paced QRS interval. The jugular approach allows for immediate post procedural ambulation.

First‐in‐man report of transsubclavian venous implantation of the Aveir leadless cardiac pacing system

“…7 A superior approach has several advantages over transfemoral, such as allowing for nonapical positioning without a need for multiple deployment attempts, immediate ambulation, and same-day discharge. 4 Transsubclavian access may be chosen over jugular access in patients with existing CVCs, jugular DVT, or preference for early ambulation and discharge. Transsubclavian LCP implantation may be of particular use in patients who underwent BOLT, as was the case with 2 of our patients.…”

Perioperative Considerations for Modern Leadless Pacemakers

“…Tortuous femoral vasculature is a relative contraindication, although there are multiple case reports of percutaneous placement using upper extremity veins. 49,50 Additionally, patients with severe obesity are not candidates, as the increased soft tissue prevents reliable telemetry communication with the implanted device. Finally, young patients require special consideration for leadless pacemakers, as these patients will likely require multiple attempted device extractions and replacements during their lifetime.…”

Leadless pacemaker implantation and azygos continuation in the inferior vena cava: a case description

“…Therefore, CT venography could be used in some situations to preoperatively assess the patient's vascular status, avoid intraoperative abandonment, and save ineffective surgical expenses. Some recent studies have reported LP implantation being conducted via the internal jugular vein (17)(18)(19)(20). Saleem-Talib et al (17,18), Kolek et al (19), and Hale et al (20) implanted 82, 1, and 1 patients, respectively.…”

“…Some recent studies have reported LP implantation being conducted via the internal jugular vein (17)(18)(19)(20). Saleem-Talib et al (17,18), Kolek et al (19), and Hale et al (20) implanted 82, 1, and 1 patients, respectively. Their results commonly showed that the jugular approach seemed to be as safe as the femoral approach.…”

“…Therefore, the jugular approach could be considered an alternative implantation method for an LP. However, the jugular approach has not been commonly adopted, which might be because a large learning curve exists (18). Despite the limited experience of current surgeons in China with this method, the internal jugular approach deserves further investigation.…”