Persistent atrial fibrillation ablation in a case of persistent left superior vena cava with absence of the right superior vena cava

The great majority of atrial fibrillation cases originate from pulmonary vein (PV) triggers; however, non-PV triggers may be the drivers of the arrhythmia, especially in the patients with a persistent left superior vena cava (PLSVC). The presence of a PLSVC may be suggested with a dilated coronary sinus on transesophageal echocardiography during the procedure and may be confirmed with an atrial angiogram, if not known beforehand. Detection and elimination of true trigger site are the most important step for clinical success in such cases.