Leadless pacing: Going for the jugular

Abstract

BackgroundLeadless 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.MethodsThe case records of all patients who underwent internal jugular venous (IJV) leadless pacemaker implantation (Micra, Medtronic, Dublin, Ireland) at our center were analyzed retrospectively.ResultsNineteen 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.ConclusionAlthough experience is minimal, we suggest that the IJV approach is safe and may be considered in patients where the femoral approach is contraindicated.

Implantation of leadless pacemakers via inferior vena cava filters is feasible and safe: Insights from a multicenter experience

“…Implanters that have a limited experience with balloon venoplasty techniques should consider involving of an interventional radiologist or an interventional cardiologist in the procedure 11 . In those with an occluded IVC filter, which is not amenable to balloon dilatation, implantation using the internal jugular venous approach may be considered 13,15 …”

“…11 In those with an occluded IVC filter, which is not amenable to balloon dilatation, implantation using the internal jugular venous approach may be considered. 13,15 If the stiff guidewire can be passed through the filter, but there is difficulty passing the 27-Fr sheath, both the wire and the sheath should…”

“…Role of preprocedural imagingAlthough preprocedural imaging was performed in six patients, the utility of this approach remains unclear. Preprocedural identification of an occluded IVC filter would facilitate planning for alternative approaches, such as the internal jugular approach 13,15. Although magnetic resonance venography can detect an IVC thrombus, its use is limited due to artifacts that are caused by the filter.…”

Leadless pacemaker placement in an 18-kilogram child: Procedural approach and technical considerations

“…The internal jugular approach also provided a more direct route to the body of the right ventricle and allowed for easy positioning on a septal location 9 . However, the relatively straight angle from the internal jugular vein to the ventricle made the movement typically seen on the Micra Delivery Catheter during the pull test less apparent than normally seen with femoral access.…”

“…We relied more heavily on transmitted cardiac pulsations on the tether cord to confirm that adequate force had been applied, after which the cineangiogram was reviewed to evaluate the widening of the nitinol wires. A limited number of prior reports have described successful implantation of leadless pacemakers via a jugular approach 9, 10. The largest series described 19 adult patients, mean age 77.5 ± 9.6 years, all of whom received a MICRA TPS by percutaneous internal jugular approach.…”