JACC Case Rep. 2026 Oct 16:110874. doi: 10.1016/j.jaccas.2026.110874. Online ahead of print.
ABSTRACT
BACKGROUND: Leadless pacemakers (LPs) are conventionally implanted transfemorally, with transjugular and subclavian routes reported as alternatives. Axillary access has not previously been reported.
FIH SUMMARY: A 78-year-old woman with chronic sacral wounds became temporary-pacing dependent following an inferior ST-segment elevation myocardial infarction. An LP was selected given infection risk. Because of a right femoral deep venous thrombosis, an abscess at the left femoral site, and restricted neck mobility limiting internal jugular access, she underwent left axillary vein implantation of an LP.
DISCUSSION: Axillary access served as a feasible alternative route. A septal position was achieved by rotating the delivery system counterclockwise, opposite the transfemoral direction, while a perpendicular sterile table supported the extracorporeal catheter length.
NOVELTY: This is the first reported axillary vein implantation of an LP.
TAKE-HOME MESSAGE: Axillary venous access is a feasible bailout route for LP implantation when femoral and internal jugular access are unavailable.
PMID:42886142 | DOI:10.1016/j.jaccas.2026.110874