A case report of successful implantation of a leadless pacemaker via the left internal jugular vein in a patient with mirror-image dextrocardia and absence of the inferior vena cava’s hepatic segment

Mirror-image dextrocardia combined with absence of the hepatic segment of the inferior vena cava (IVC) and continuation of the azygos vein represents an extremely rare dual anatomical variation that significantly increases the technical complexity of leadless pacemaker (LP) implantation. This paper presents a 28-year-old male patient who required permanent pacing therapy due to third-degree atrioventricular block. Preoperative computed tomography angiography (CTA) clearly identified the aforementioned malformations. A Micra AV leadless pacemaker was subsequently implanted successfully via the left internal jugular vein. During the procedure, image mirroring technology was employed to assist the operation, ensuring precise deployment and stable parameters. This case marks the world's first successful LP implantation via the internal jugular vein in a patient with such complex anatomical variations, offering a novel, safe, and feasible approach for similar patients.