Jugular Versus Femoral Venous Access for Leadless Pacemaker Implantation: A Systematic Review and Meta-Analysis

Background Leadless pacemakers (LPMs) have been shown to reduce complications compared with conventional transvenous pacing. Transfemoral venous access (FA) is the standard implantation approach; however, the transjugular approach (JA) has recently emerged as an alternative strategy, but comparative evidence remains limited. Therefore, we perform a systematic review and meta-analysis comparing JA and FA for LPMs implantation in terms of electrical performance, procedural efficiency, and complications.Methods All studies comparing JA and FA for LPMs were systematically identified. Pooled analyses were performed for pacing threshold, sensed R-wave amplitude, impedance, total procedural time, fluoroscopy duration, and procedural complications.Results Three observational studies were included. No significant differences were observed between FA and JA in mean pacing threshold (MD 0.05 ms; 95% CI -0.03 to 0.12), mean sensed R-wave amplitude (MD 0.31 mV; 95% CI -0.51 to 1.14), or impedance (MD 45.79 Omega; 95% CI -27.03 to 118.61). Total procedural time was comparable between approaches (MD -0.44 min; 95% CI -8.47 to 7.60). JA was associated with a significant reduction in fluoroscopy time compared with FA (MD 2.73 min; 95% CI 0.66 to 4.81). JA also significantly reduced overall procedural complications (1.8% vs. 15%; OR 0.12, 95% CI 0.04 to 0.39) and wound care-related adverse events (0% vs. 14%; OR 0.07, 95% CI 0.01 to 0.36). No differences were observed in device dislodgement, pericardial effusion, or emergent device removal.Conclusions JA provides comparable electrical performance to FA while reducing fluoroscopy exposure and access-related complications, supporting its use as a safe alternative for LPMs implantation