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. 2019 Apr;42(4):395-399.
doi: 10.1111/pace.13607. Epub 2019 Feb 25.

Leadless pacing: Going for the jugular

Shmaila Saleem-Talib  1 , Vincent J van Driel  1 , Sevasti-Maria Chaldoupi  1 , Tanja Nikolic  1 , Harry van Wessel  1 , C Jan Willem Borleffs  1 , Hemanth Ramanna  1
Affiliations

Leadless pacing: Going for the jugular

Shmaila Saleem-Talib et al. Pacing Clin Electrophysiol. 2019 Apr.

Abstract

Background: Leadless pacing is generally performed from a femoral approach. However, the femoral route is not always available. Until now, data regarding implantation using a jugular approach other than a single-case report were lacking.

Methods: The case records of all patients who underwent internal jugular venous (IJV) leadless pacemaker implantation (Micra, Medtronic, Dublin, Ireland) at our center were analyzed retrospectively.

Results: Nineteen patients underwent IJV leadless pacemaker implantation, nine females, mean age of 77.5 ±9.6 years; permanent atrial fibrillation in all patients with normal left ventricular ejection fraction. Implant indication was atrioventricular conduction disturbance in 10, pre-AV node ablation in seven, and replacement of a conventional VVI pacemaker in two (infection in one and lead malfunction in the other). The device was positioned at the superior septum in seven patients, apicoseptal in seven patients, and midseptal in five patients. In 12 patients, a sufficient device position was obtained at the first attempt, in three at the second, in one at the third, in one at the fourth, and in two at the sixth attempt. The mean pacing threshold was 0.56 ± 0.39V at 0.24-ms pulse width, sensed amplitude was 9.1 ± 3.2 mV, mean fluoroscopy duration was 3.1 ± 1.6 min. There were no vascular or other complications. At follow-up, electrical parameters remained stable in 18 of 19 patients.

Conclusion: Although experience is minimal, we suggest that the IJV approach is safe and may be considered in patients where the femoral approach is contraindicated.

Keywords: jugular vein; leadless pacing; pacemaker.

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Conflict of interest statement

Tanja Nikolic is employed by Medtronic and Harry van Wessel is employed by Abbott. Other authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Right anterior oblique fluoroscopic images to confirm the device position on the apical septum
Figure 2
Figure 2
Left anterior oblique fluoroscopic images of the device positioned on the apical septum with contrast injection to confirm septal localization. The delivery tool enters the right atrium from the superior caval vein
See this image and copyright information in PMC

References

    1. Kolek M, Crossley GH, Ellis CR. Implantation of a MICRA leadless pacemaker via right internal jugular vein. JACC Clin Electrophysiol. 2018;4:420‐421. - PubMed
    1. Daily PO, Griep RB, Shumway NE. Percutaneous internal jugular vein canulation. Arch Surg. 1970;101:534‐536. - PubMed
    1. Cantillon DJ, Dukkipati SR, Ip JH, et al. Comparative study of acute and mid‐term complications with leadless and transvenous cardiac pacemakers. Heart Rhythm. 2018;15:1023‐1030. - PubMed
    1. Flege JB Jr, Wolf RK. Venous drainage to the heart‐lung machine via the internal jugular vein. Ann Thorac Surg. 1997;63:861. - PubMed
    1. Bongiorni MG, Della Tommasine V, Barletta V, et al. Feasibility and long term effectiveness of a non‐apical Micra pacemaker implantation in a referral centre for lead extraction. Europace. 2019;21:114‐120. - PubMed