Cryoballoon Pulmonary Vein Isolation via a Single Right Internal Jugular Approach Using Fluoroscopy Alone in a Patient with Bilateral Lower-Extremity Venous Occlusion.

Pulmonary vein isolation (PVI) for atrial fibrillation is typically performed via femoral venous access. When inferior venous access is unavailable, alternative approaches are required. We report a case of successful cryoballoon PVI performed via a single right internal jugular vein access using fluoroscopy alone under conscious sedation in a patient with complete bilateral lower-extremity venous occlusion. Following failed femoral access and venographic confirmation of occlusion, transseptal puncture and ablation were achieved using biplane fluoroscopic guidance without transesophageal or intracardiac echocardiography, coronary sinus catheterization, or general anesthesia. All pulmonary veins were successfully isolated without complications, and the patient was discharged the following day in sinus rhythm. This case demonstrates that a minimalist, superior-only approach to cryoballoon PVI is feasible and effective when standard inferior access is not possible.