Radiofrequency wire–facilitated transseptal access using a superior approach for atrial fibrillation ablation in a patient with inferior vena cava obstruction

Introduction The standard approach to contemporary atrial fibrillation ablation involves obtaining trans-septal access to the left atrium from an inferior approach using percutaneous femoral venous access. Rarely, access to the heart from the inferior approach is not possible due to vascular anomalies or venous occlusions. In these unusual cases, a superior approach to pulmonary vein isolation could be considered. In the case report herein, we describe a novel technique for performing trans-septal access from the right internal jugular vein in a patient with bilateral internal iliac/IVC occlusion using radiofrequency and exchange pigtail wires.