Pulmonary Vein Isolation and Concomitant Posterior Wall Box Isolation with Pulsed Field Ablation Using a Right Transjugular Access in a Patient with Long-Standing Persistent Atrial Fibrillation

Case Report

Volume 6, Issue 2

Pulmonary Vein Isolation and Concomitant Posterior Wall Box Isolation with Pulsed Field Ablation Using a Right Transjugular Access in a Patient with Long-Standing Persistent Atrial Fibrillation

Stefan Mueller, Alexander Lucius^* and Stephan Kische

Vivantes Klinikum im Friedrichshain, Department of Cardiology, Landsberger Allee 49, 10249 Berlin Germany

^*Corresponding author: Alexander Lucius, Vivantes Klinikum im Friedrichshain, Department of Cardiology, Landsberger Allee 49, 10249 Berlin Germany.
E-mail: alexander.lucius@vivantes.de

Received: January 27, 2026; Accepted: February 16, 2026; Published: March 05, 2026

Citation: Mueller S, Lucius A, Kische S. Pulmonary Vein Isolation and Concomitant Posterior Wall Box Isolation with Pulsed Field Ablation Using a Right Transjugular Access in a Patient with Long-Standing Persistent Atrial Fibrillation. Case Rep Clin Cardiol J. 2026; 6(2): 175.

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Pulmonary Vein Isolation and Concomitant Posterior Wall Box Isolation with Pulsed Field Ablation Using a Right Transjugular Access in a Patient with Long-Standing Persistent Atrial Fibrillation

Abstract

Superior transjugular access may be required when common transfemoral catheterization is not possible. We present the first reported case of pulmonary vein isolation (PVI) and concomitant posterior wall isolation using pulsed field ablation (PFA) via a jugular approach supported by 3D mapping. A 56-year-old patient with persistent atrial fibrillation and chronic inferior vena cava occlusion underwent PVI after a failed femoral attempt. Transseptal puncture directly with the steerable PFA sheath was challenging but feasible under transesophageal echocardiography. The 3D mapping system revealed persistent conduction gaps in the superior veins despite apparent exit block and uncovered additional substrate on the posterior wall. After 90 PFA applications, complete isolation of all veins and the posterior wall was achieved. This case demonstrates that jugular-access PFA is possible but complex, and that 3D mapping significantly enhances navigation and gap detection.

Keywords: Atrial fibrillation; Pulsed field ablation; Jugular vein access; FaraPulse; Pulmonary vein isolation

Article Details

Pulmonary Vein Isolation and Concomitant Posterior Wall Box Isolation with Pulsed Field Ablation Using a Right Transjugular Access in a Patient with Long-Standing Persistent Atrial Fibrillation