Total upper body drainage via left superior vena cava into coronary sinus (i.e. absent right superior vena cava) is a rare anomaly and distorts the anatomy of coronary sinus and triangle of Koch. Herewith we are reporting the first report of ablation in a patient with superior vena cava draining into coronary sinus totally. This patient with atrioventricular nodal re-entrant tachycardia, baseline left bundle branch block, transient complete heart block during electrophysiological study and total upper body venous drainage into coronary sinus had successful slow pathway ablation using anatomical approach.