Key result
Right internal jugular PVI with a lattice-tip catheter overcomes superior access challenges in IVC occlusion.
Case Report
The text describes a technical approach for pulmonary vein isolation via the right internal jugular vein using a lattice-tip catheter to overcome the challenges of inferior vena cava occlusion.
May offer feasible superior-access pulmonary vein isolation in inferior vena cava occlusion; leaves open prospective validation of safety and durability.
Pulmonary vein isolation (PVI) is the cornerstone of rhythm control for symptomatic, drug-refractory atrial fibrillation (AF) and carries a Class I recommendation in contemporary guidelines.1 PVI is conventionally performed through femoral venous access and the inferior vena cava (IVC). When the IVC is obstructed or occluded, a superior approach via the internal jugular (IJ) or axillary/subclavian vein is required.2–4 Superior access introduces substantial technical challenges including difficult engagement of the fossa ovalis, an unfavorable transseptal vector, and constrained catheter maneuverability; and this approach has historically demanded multiple catheter exchanges across energy platforms.
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Ahmed et al. (2026) conducted a case report in Atrial fibrillation with inferior vena cava occlusion. Pulmonary vein isolation and linear ablation via the right internal jugular approach using a lattice-tip catheter was evaluated. Pulmonary vein isolation via the right internal jugular approach using a lattice-tip catheter addresses the technical challenges of superior access in patients with inferior vena cava occlusion.
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