Novel approach to pulmonary vein isolation ablation via right internal jugular access: A case report

BACKGROUND Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide, hosting numerous serious possible complications such as stroke and heart failure. In the past two decades, managing rhythm control was more successful via pulmonary vein isolation (PVI) ablation, generally performed via transfemoral access. Patients with anatomical variations may necessitate a dose of creativity and evidence-based techniques. To our knowledge, we present the first PVI case in a patient with AF via right internal jugular (IJ) vein access using pulse field ablation. CASE SUMMARY A 76-year-old male with an extensive medical history notable for type 2 diabetes and severe peripheral vascular disease requiring vascular bypass surgery is identified to have paroxysmal AF. Given functional decline and worsening arrhythmia burden refractory to oral antiarrhythmics, an initial PVI ablation was attempted but failed as the catheter could not be advanced secondary to bilateral iliac vein occlusions. This necessitated a novel approach and a subsequent PVI ablation via the right IJ vein was successful without any complications. The success of this case highlights the feasibility of an IJ approach for PVI in patients where traditional access is not possible. This case can be used as a reference for other practitioners who may face similar challenges when attempting to perform PVI for AF or similar procedures requiring access to similar anatomical locations. CONCLUSION The success of this case highlights the feasibility of an IJ approach for PVI when traditional access is impossible.