Jugular Journeys: A Novel Approach for AVEIR Leadless Pacemaker Implantation

BACKGROUND: The jugular approach for Micra leadless pacemaker (LP) implantation offers potential advantages over the femoral route, however data on safety and feasibility for the relatively larger AVEIR LP implantation through the jugular vein is limited. This study evaluated the procedural safety and short-term clinical outcomes of AVEIR ventricular LP implantation via the internal jugular vein (IJV). METHODS: All consecutive patients undergoing AVEIR LP implantation via the IJV at our center between November 2023 and July 2025 were included. Procedural details, device electrical parameters and complications were collected from patient electronic records. RESULTS: Eighteen patients (median age 76 years, 33% female) had an AVEIR LP implantation via the IJV. Implantation was successful in 17/18 patients (94%). The median duration of the procedures was 65.5 min (45.0-134.0) with a median fluoroscopy time of 11.2 min (7.4-42.3). Median follow-up time was 9.9 months (0.6-19.5). During follow up the device electrical parameters remained stable with, mean R-wave amplitude 8.83 mV ± 3.6, pacing threshold 0.75 V. ± 0.4 V and impedance 730 ± 338 Ω; with an average estimated battery longevity of 16.0 ± 4.5 years. Two minor procedural complications occurred: one requiring conversion to femoral access, and one requiring an additional transvenous pacemaker lead due to elevated pacing thresholds. No vascular complications were observed. CONCLUSION: AVEIR ventricular LP implantation via the IJV is safe and feasible, with stable electrical performance, during short-term follow-up. While the larger device size may challenge AVEIR implantations in smaller hearts, using the delivery sheath as a support to create a sharper curve facilitates the procedure.