Abstract Body (Do not enter title and authors here):
Background: Leadless pacemaker therapy has emerged as a transformative alternative to conventional transvenous systems, mitigating lead- and pocket-related complications. While the femoral vein remains the standard access route, anatomical constraints and vascular complications have prompted exploration of the internal jugular vein (IJV) as a viable alternative for successful procedure in both adult and pediatric populations.

Purpose: Systematically evaluate the efficacy and safety of leadless pacemaker implant via the IJV.

Methods: Multiple databases were searched up to May 2025 for studies evaluating the efficacy and safety of leadless pacemaker implant IJV access. The extracted data of three studies included procedural success rates, complication incidence, and electrical performance parameters. Prevalences were pooled using events per outcome group and mean differences (MDs), along with 95% confidence intervals (CIs), and I2 for heterogeneity, employing the Mantel-Haenszel random-effects model.

Results: Three observational studies comprising 117 patients were included, with 100 adults (mean age: 81.18 ± 8.29 years) and 17 children (mean age: 11.45 ± 4.97 years). The IJV achieved a 100% procedural success rate (95% CI: 99.18%–100%) in both adult and pediatric populations, with no need for femoral bailout access or reported vascular complications. The pooled first-attempt success rate was 83% (95% CI: 45.89%–96.58%). The overall complication rate was low at 2.56% (95% CI: 0.83%–7.65%), including a 1.71% incidence of cardiac effusion (95% CI: 0.43%–6.58%). Successful mid-septal implantation was achieved in 26% of cases (95% CI: 7.76%–59.46%). Post-procedural pacing parameters as impedance, R-wave sensing, and threshold, were within acceptable limits at procedure completion and remained stable during follow-up (range: 0.5 - 43 months).

Conclusion: The IJV approach has emerged as a highly effective and safe strategy for leadless pacemaker implantation. It offers several compelling advantages, including high procedural success, low complication rates, and improved patient comfort. Notably, IJV access enables optimal non-apical device positioning, which may reduce the risk of pacing-induced cardiomyopathy while maintaining favorable and stable long-term electrical parameters. Further large-scale, randomized studies are needed to validate these promising outcomes and support broader adoption of the IJV approach.