Superior vena cava (SVC) is one of the most important non-pulmonary vein (PV) origins of atrial fibrillation (AF), and SVC isolation (SVCI) is considered especially in patients with paroxysmal AF. Despite the fact that the SVCI is effective, the prophylactic SVCI is still controversial. There are two major different approaches to treat SVC focus in the ablation of AF. The conventional approach is that the SVCI would be performed only if AF from the SVC origin is actually recognized using pacing maneuvers and/or isoproterenol infusions. Another approach is the prophylactic SVCI in addition to PV isolation in all cases. The rate of AF freedom one year after initial AF ablation by prophylactic SVCI was almost same as the conventional method (85-90% AF freedom). Additionally, the conventional method has also a good result even 5 years after ablation, which was 73.3%. Because of the excellent result in the conventional approach and possible complications after the SVCI, the prophylactic SVCI for all AF cases would not be the standard approach. Patients with a long SVC myocardial sleeve are possible candidates for prophylactic SVCI.