Congenital cardiac anomalies pose a significant challenge during cardiac ablation procedures. Pre-procedural multimodality imaging can help to identify these incidental findings, which may assist with procedural planning to achieve successful outcomes. Here, we describe the technical challenges associated with cryoballoon ablation of the pulmonary veins in a patient with persistent left superior vena cava who was found to have right superior vena cava atresia during the case.