Key result
Balloon-in-basket PFA via SVC approach achieves PVI with 0 complications or recurrences at short-term follow-up.
Why the study?
In patients requiring pulmonary vein isolation for atrial fibrillation who have an interrupted inferior vena cava, alternative access routes such as the superior vena cava approach are required.
Case Report (n=1)
No
This case demonstrates the feasibility and safety of using a balloon-in-basket pulsed-field ablation system via the superior vena cava approach for atrial fibrillation ablation in patients with interrupted inferior vena cava.
Enables PVI via SVC with BiB-PFA in interrupted IVC; leaves open generalizability and durability.
Background Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation for atrial fibrillation (AF) and is typically performed via transfemoral access. In patients with interrupted inferior vena cava (IVC), however, alternative access routes such as superior vena cava (SVC) approach are required. A balloon-in-basket (BiB)-pulsed field ablation (PFA) is a novel non-thermal ablation modality that offers stable positioning and uniform tissue contact. Case summary A 66-year-old male with symptomatic persistent AF characterized by palpitations and interrupted IVC was referred to our institution. Catheter ablation using a BiB-PFA system via the SVC approach was planned. Transseptal puncture was successfully achieved under transesophageal echocardiographic and fluoroscopic guidance. PVI was achieved using the BiB-PFA catheter. Additional left atrial posterior wall (LAPW) isolation was performed with selective electrode activation to avoid anterior wall delivery. The procedure was completed without complications. At the 3-month follow-up, no recurrence of atrial tachyarrhythmia was detected on Holter monitoring, and the patient remained asymptomatic. Discussion This case highlights the feasibility and safety of performing PVI and LAPW isolation via the SVC approach using the BiB-PFA system in a patient with interrupted IVC. The BiB-PFA system provides stable catheter manipulation and allows targeted lesion delivery through selective electrode activation. Although limited by its single-case nature and short follow-up, this report suggests that the BiB-PFA system may expand the therapeutic options for patients with complex venous anatomy.
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Ukita et al. (2026) conducted a case report in Symptomatic persistent atrial fibrillation with interrupted inferior vena cava (n=1). Balloon-in-basket pulsed-field ablation (BiB-PFA) via superior vena cava approach was evaluated on Procedural complications and recurrence of atrial tachyarrhythmia. Balloon-in-basket pulsed-field ablation via the superior vena cava approach achieved pulmonary vein isolation with 0 procedural complications and 0 atrial tachyarrhythmia recurrences at 3 months.
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