Atrial Fibrillation Ablation Without Pulmonary Vein Isolation in a Patient with Fontan Palliation

In a patient with Fontan palliation and persistent atrial fibrillation two triggers were identified that initiated atrial fibrillation (AF) from the superior vena cava (SVC) and the right atrium. SVC triggers are more common in patients with a normal-sized left atrium. Eliminating these triggers prevented AF from being sustained in this patient and thus pulmonary vein isolation was not pursued. The patient has remained AF free for 3 years without medications or repeat ablation. Targeting of potential right-sided triggers for AF ablation, before pulmonary vein isolation, should be considered; such an approach may reduce risks in these complex patients.