Transhepatic Access for Pulsed Field Ablation of Atrial Fibrillation Using a Dual-Energy Lattice-Tip Catheter

BACKGROUND: In patients with interrupted inferior vena cava (IVC) requiring atrial fibrillation (AF) ablation, transhepatic access is an established alternative to femoral venous access. Prior reports have described AF ablation using radiofrequency platforms, but, to our knowledge, transhepatic AF ablation with a dual-energy lattice-tip catheter integrating high-density mapping, pulsed field ablation, and radiofrequency ablation has not been reported. CASE SUMMARY: We describe 3 patients with symptomatic AF and interrupted IVC who underwent successful transhepatic left atrial access using ultrasound-guided placement of a 12-F hemostatic sheath. Pulmonary vein isolation and posterior wall isolation were performed with pulsed field ablation in all patients. Hepatic tract closure was achieved using absorbable gauze within the hepatic parenchyma. No access-related or procedural complications occurred, and all patients recovered uneventfully. DISCUSSION: This series demonstrates the feasibility of transhepatic AF ablation using a dual-energy lattice-tip catheter. Further studies are needed to define procedural safety and long-term outcomes.