Right Internal Jugular Transseptal Puncture for Wolff–Parkinson–White Syndrome Ablation in a Patient with Interrupted Inferior Vena Cava and Azygos Continuation

Catheter ablation of left-sided accessory pathways typically requires femoral venous access with transseptal puncture; however, congenital interruption of the inferior vena cava (IVC) with azygos continuation makes this approach impractical. We report a 20-year-old man with Wolff–Parkinson–White syndrome in whom an interrupted IVC with azygos continuation was discovered during the procedure. After failed attempts using a retrograde aortic approach due to poor catheter stability, left atrial access was successfully achieved via a right internal jugular vein transseptal puncture guided by biplane fluoroscopy alone. A deflectable sheath provided stable mapping and enabled successful ablation of a left free-wall accessory pathway without complications. Post-procedural computed tomography confirmed the venous anomaly. This case highlights the right internal jugular vein transseptal approach as a feasible and effective alternative for left atrial access in patients with interrupted IVC when femoral access is not possible, provided the procedure is performed in experienced centers.

Keywords: Interrupted inferior vena cava, jugular transseptal puncture, Wolff–Parkinson–White syndrome