Lester John R, Abolhassani Ali, Patel Himax, Hreibe Haitham
Department of Cardiology, Wellstar MCG Health Medical Center, Augusta, GA 30912, United States.
World J Cardiol. 2025 Jul 26;17(7):108901. doi: 10.4330/wjc.v17.i7.108901.
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 pulmonary vein isolation (PVI) ablation, generally performed 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 right internal jugular (IJ) vein access using pulse field ablation.
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 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.
The success of this case highlights the feasibility of an IJ approach for PVI when traditional access is impossible.
心房颤动（AF）是全球最常见的心律失常，存在许多严重的潜在并发症，如中风和心力衰竭。在过去二十年中，节律控制管理在肺静脉隔离（PVI）消融方面更为成功，通常通过经股途径进行。解剖结构变异的患者可能需要一定的创新和循证技术。据我们所知，我们报告了首例通过右颈内静脉（IJ）途径使用脉冲场消融治疗心房颤动患者的PVI病例。
一名76岁男性，有2型糖尿病和严重外周血管疾病病史，因严重外周血管疾病需要进行血管搭桥手术，被诊断为阵发性房颤。鉴于其功能下降且口服抗心律失常药物难以控制心律失常负担加重，首次尝试进行PVI消融，但由于双侧髂静脉闭塞导致导管无法推进而失败。这就需要一种新方法，随后通过右IJ静脉进行PVI消融获得成功，且无任何并发症。该病例的成功突出了在无法采用传统途径时IJ途径进行PVI的可行性。该病例可为其他在尝试对房颤进行PVI或进行需要进入类似解剖部位的类似手术时可能面临类似挑战的从业者提供参考。
该病例的成功突出了在传统途径不可行时IJ途径进行PVI的可行性。
