Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands.
Europace. 2024 Aug 3;26(8). doi: 10.1093/europace/euae199.
Leadless pacemaker therapy was introduced to overcome lead- and pocket-related complications in conventional transvenous pacemaker systems. Implantation via the femoral vein, however, may not always be feasible. The aim of this study was to evaluate leadless pacemaker implantation using a jugular vein approach and compare it to the standard implantation via the femoral vein.
The records of the first consecutive 100 patients undergoing Micra™ leadless pacemaker implantation via the right internal jugular vein from two centres were included in this study. Peri-procedural safety and efficacy of the jugular approach were compared to the first 100 patients using a femoral implantation approach at the University Hospital Zurich. One hundred patients underwent successful implantation of a leadless pacemaker via the internal jugular vein (mean age, 81.18 ± 8.29, 60% males). Mean procedure time was 35.63 ± 10.29 min with a mean fluoroscopy time of 4.66 ± 5.16 min. The device was positioned at the inferior septum in 25 patients, at the high septum in 24 patients, and mid-septum in 51 patients. The mean pacing threshold was 0.56 ± 0.35 V at 0.24 ms pulse width with a sensed amplitude of 10.0 ± 4.4 mV. At follow-up, electrical parameters remained stable in all patients. Compared with femoral implantation, patients undergoing the jugular approach were of similar age and had similar comorbidities. Mean procedure (48.9 ± 21.0 min) and fluoroscopy times (7.7 ± 7.8 min, both P < 0.01) were shorter compared to the femoral approach. Electrical parameters were similar between the two approaches. There were only two complications during jugular veinous implantations (1 pericardial effusion and 1 dislocation), compared to 16 complications using the femoral approach (1 pericardial effusion, 2 femoral artery injuries, and 13 major groin haematomas).
The jugular approach may represent a safe and efficient alternative to femoral implantation of the Micra leadless pacemaker.
无导线起搏器治疗的引入是为了克服传统经静脉起搏器系统中与导线和囊袋相关的并发症。然而，经股静脉植入有时可能并不总是可行。本研究的目的是评估经颈内静脉入路植入无导线起搏器，并将其与经股静脉植入标准方法进行比较。
本研究纳入了来自两个中心的前 100 例连续接受经右颈内静脉植入 Micra 无导线起搏器的患者的记录。比较了颈内静脉入路的围手术期安全性和疗效与苏黎世大学医院前 100 例经股静脉植入患者的情况。100 例患者成功经颈内静脉植入无导线起搏器（平均年龄 81.18 ± 8.29 岁，60%为男性）。平均手术时间为 35.63 ± 10.29 分钟，平均透视时间为 4.66 ± 5.16 分钟。该设备被定位在下间隔 25 例，高间隔 24 例，中间隔 51 例。平均起搏阈值为 0.56 ± 0.35 V，脉宽为 0.24 ms，感知幅度为 10.0 ± 4.4 mV。随访时，所有患者的电参数均保持稳定。与股静脉植入相比，颈内静脉入路组患者的年龄和合并症相似。手术时间（48.9 ± 21.0 分钟）和透视时间（7.7 ± 7.8 分钟，均 P < 0.01）均明显短于股静脉入路组。两种方法的电参数相似。颈内静脉入路仅发生 2 例并发症（1 例心包积液，1 例脱位），而股静脉入路发生 16 例并发症（1 例心包积液，2 例股动脉损伤，13 例股部血肿）。
颈内静脉入路可能是经股静脉植入 Micra 无导线起搏器的安全有效的替代方法。
