From the Guidelines
Cardiac radiofrequency ablation (RFA) procedures typically utilize catheters as the primary vessels for accessing the heart. These catheters are thin, flexible tubes that are inserted through blood vessels (usually the femoral vein in the groin, but sometimes through the subclavian or internal jugular veins) and guided to the heart 1. The catheters contain electrodes at their tips that can deliver energy (radiofrequency, cryotherapy, laser, or ultrasound) to destroy small areas of heart tissue causing abnormal heart rhythms. Different types of ablation catheters exist, including irrigated-tip catheters that cool the tip during energy delivery, contact force-sensing catheters that measure pressure against heart tissue, and circular mapping catheters for procedures like pulmonary vein isolation. The choice of catheter depends on the specific arrhythmia being treated, the approach needed, and physician preference. Some key considerations for catheter ablation include:
- Access to the left atrium is achieved via transseptal puncture 1
- Visualization with intracardiac echocardiography is often utilized to improve safety and to monitor therapy during energy delivery during AF ablation 1
- The use of imported 3-dimensional images of the left atrium acquired either through cardiac magnetic resonance imaging or computed tomography scan can facilitate AF ablation 1 These specialized catheters allow cardiologists to perform precise ablations while minimizing damage to surrounding healthy tissue. Overall, the use of catheters in cardiac RFA has revolutionized the field of electrophysiology, providing a safe and highly effective treatment for symptomatic patients with supraventricular tachycardia 1.
From the Research
Vessel Used for Cardiac Radiofrequency Ablation (RFA)
- The vessel used for cardiac radiofrequency ablation (RFA) can vary depending on the patient's anatomy and the specific procedure being performed 2, 3, 4, 5.
- In some cases, the internal jugular vein can be used as an alternative access site for RFA, particularly in patients with interrupted or absent inferior vena cava (IVC) 3, 4, 5.
- The transseptal approach from the femoral vein is commonly used for RFA, but it may not be possible in patients with obstacles in the inferior vena cava 4.
- A superior approach, such as through the internal jugular vein or axillary/subclavian vein, can be considered in patients where a standard transfemoral venous approach is not possible 3, 5.
Specific Studies
- A study published in 2025 used the jugular vein for pulsed-field ablation of atrial fibrillation using the Farapulse system 2.
- A study published in 2020 described the technique and outcomes of atrial fibrillation ablation via a superior approach in patients with interrupted or absent IVCs 3.
- A study published in 2013 demonstrated the safety and feasibility of catheter ablation of left ventricular tachycardia via the transseptal approach from the right internal jugular vein 4.
- A study published in 2020 described the technique for obtaining left atrial catheterization and performing catheter ablation of atrial fibrillation from a superior approach 5.