Case Report
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jul 26, 2025; 17(7): 108901
Published online Jul 26, 2025. doi: 10.4330/wjc.v17.i7.108901
Novel approach to pulmonary vein isolation ablation via right internal jugular access: A case report
John R Lester, Ali Abolhassani, Himax Patel, Haitham Hreibe
John R Lester, Ali Abolhassani, Himax Patel, Haitham Hreibe, Department of Cardiology, Wellstar MCG Health Medical Center, Augusta, GA 30912, United States
Author contributions: Lester JR and Abolhassani A authored the report; Patel H edited the report; Patel H and Hreibe H revised the report; Hreibe H performed the procedure.
Informed consent statement: The patient in this study provided informed verbal consent prior to the authorship of this case report.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: John R Lester, Department of Cardiology, Wellstar MCG Health Medical Center, 1120 15th Street, Augusta, GA 30912, United States. johlester@augusta.edu
Received: April 25, 2025
Revised: May 29, 2025
Accepted: July 4, 2025
Published online: July 26, 2025
Processing time: 88 Days and 13.5 Hours
Abstract
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.

Keywords: Atrial fibrillation; Pulmonary vein isolation; Ablation; Internal jugular; Case report

Core Tip: Atrial fibrillation is typically ablated using pulmonary vein isolation through transfemoral venous access. When this is not possible, alternative entry points are required. The patient showcased in the case report had bilateral femoral vein occlusions due to chronic thrombosis requiring access via the right internal jugular vein. Successful ablation was performed, and the patient was discharged the same day. This case highlights the feasibility of internal jugular vein access for pulmonary vein isolation as well as the importance of physician adaptability in unexpected circumstances.