Feasibility of Atrial Fibrillation Ablation via Right Internal Jugular Access Using a Lattice-Tip Pulsed Field Ablation System in the Presence of Inferior Vena Cava Aplasia: First Clinical Experience.

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  Figure 1. Procedural imaging and navigational approach. (A) Three-dimensional electroanatomical reconstruction (Affera Prism-1™) demonstrating complete inferior vena cava aplasia with venous drainage diverted via a dilated azygous vein into the superior vena cava; the inset provides a fluoroscopic angiogram confirming the anomalous venous trajectory. (B) Intracardiac echocardiography visualization from the azygous vein (posterior vantage point) showing the interatrial septum, fossa ovalis, and adjacent aortic valve, facilitating safe transseptal puncture from the superior approach. (C, D) Fluoroscopic views (left anterior oblique projections) showing the Sphere-9™ lattice-tip catheter positioned at the antrum of the left superior pulmonary vein and right inferior pulmonary vein via the Agilis™ steerable sheath, introduced through the right internal jugular vein.