Pulmonary Veins, Posterior Wall, and Non–Pulmonary Vein Trigger Ablation in Persistent Atrial Fibrillation and Dextrocardia

Persistent atrial fibrillation in patients with dextrocardia presents unique technical challenges due to reversed cardiac anatomy. We report a case of successful catheter ablation in a 68-year-old man with dextrocardia and long-standing persistent atrial fibrillation. Using multimodal imaging and high-density electroanatomic mapping, pulmonary vein isolation, posterior wall isolation, and non-pulmonary vein triggers ablation were performed, restoring stable sinus rhythm. The patient remained arrhythmia-free at 12 months. TAKE-HOME MESSAGE: Atrial fibrillation ablation in patients with dextrocardia requires a tailored approach that incorporates multimodality imaging to navigate complex anatomy safely and effectively.