Injection Through the right antecubital vein; (C) opacification was seen in CS before reaching RA

Procedure was tried one more time guided TEE. After adequate prep and drape, four access were obtained from right femoral vein. Then catheters passed into the veins and lead tip placed in RA, RV, His and CS. A guiding passed from interatrial septum (septostomy was done via TEE guiding) and ablation catheter was inserted in LA.

The earliest retrograde atrial activation was recorded in the CS 7-8. Radio-frequency (RF) energy delivered to posterior ring of MV, but could not eliminate the bypass tract; however, the ablation site changed to posteromedially site of MV and posterolaterally site but ablation was failed again. Irrigated catheter exited from LA and was inserted in CS, ablation was done in 4 o’clock to 5 o’clock region of the mitral annulus which not resulted to VA dissociation. Because of instability of the ablation catheter and inaccurate repositioning during ablation, for evaluation of systemic venous anomalies an access was inserted in left subclavian vein, guiding fluoroscopy, then contrast was injected, the findings included sever dilation of CS with abnormal drainage of right venosus system (Fif-3), as the patient had no right SVC. Right venosus system drained into left persistent SVC.