Background <p>Although leadless pacemakers are traditionally implanted utilizing femoral venous access, the right internal jugular vein is an alternative site that may be preferable for patients with complex vasculature or contraindications to femoral access. The purpose of this study is to evaluate the safety, feasibility, and procedural efficiency of the AVEIR VR leadless pacemaker implantation via the right internal jugular venous access compared to traditional right femoral venous access in adult patients.</p> Methods <p>This is a retrospective, single-center study of all adult patients who received an AVEIR VR device at our facility. Patients were stratified by venous access site (right femoral vein or right internal jugular vein), and patient outcomes were collected from device implant until the 3-month follow-up visit. Comparison between groups was performed using the intention-to-treat protocol.</p> Results <p>A total of 56 patients (24 right femoral, 32 right internal jugular) were included in this study. Baseline characteristics were shown to be equivalent between the groups. There was no significant difference in adverse events or pacemaker metrics (device threshold, sensing, impedance) between the two groups.</p> Conclusion <p>Right internal jugular venous access is a feasible and safe alternative to femoral access for AVEIR VR implantation. With proper operator and anesthetist experience, procedural outcomes and device performance are comparable to those achieved with the standard femoral approach.</p> Graphical Abstract <p></p>