Comparison of transjugular and transfemoral approaches for leadless pacemaker implantation in asian patients: a retrospective analysis

Abstract Background The transfemoral approach is the conventional method for leadless pacemaker implantation. However, inspired by previous studies suggesting potential advantages of the transjugular approach, we aimed to evaluate its safety and effecacy, especially for smaller-statured Asian patients, in terms of acute procedural outcomes and complications. Methods The case records of all patients who underwent transjugular or transfemoral leadless pacemaker implantation at our center between March 2021 and October 2024 were analyzed retrospectively. The choice of approach was made at the physician's discretion rather than technical feasibility. Results We analyzed 98 patients: 78 were treated via the transfemoral approach, and 20 via the transjugular approach. The mean age was 72.0 years, and 61.2% were male. Device indications, including sinus node dysfunction, atrioventricular block, and atrial fibrillation with slow ventricular response, did not differ significantly between the groups. All devices were positioned at the midseptal area, with no dislodgement reported in either group. The mean number of attempts for successful implantation was 2.3 ± 2.0 overall (2.4 ± 2.1 for transfemoral vs. 2.1 ± 1.6 for transjugular; P = 0.492). There was no significant difference between group in procedural and fluoroscopic times, paced QRS duration, or pacing parameters, including pacing threshold, impedance, and sensed amplitude. Howver the transjugular group had a significantly lower rate of puncture site complications (5.0% vs. 35.9%, P = 0.025; odds ratio 10.6, 95% CI: 1.35–83.77) and a shorter procedure-to-discharge time (1.4 ± 0.6 vs. 2.2 ± 1.4 days, P = 0.039). Conclusion The transjugular approach for leadless pacemaker implantation appears to offer a lower rate of puncture site complications with comparable efficacy to the transfemoral approach, suggesting a viable alternative in Asian patients.