Key Teaching Points•Ablation of tricuspid valve arrhythmias from a femoral approach can be challenging. The valve leaflets often limit contact between the ablation catheter and the myocardial tissue.•In some patients with failed ablation attempts, successful arrhythmia elimination may be achieved by positioning the ablation catheter from below the tricuspid annulus, as opposed to the standard approach above the annulus. Intracardiac echocardiography (ICE) is essential in these cases to monitor for real-time catheter position.•For arrhythmias originating from the anterior tricuspid annulus we describe a novel ICE-guided technique involving the aid of a long sheath and a "double S" configuration on the ablation catheter. •Ablation of tricuspid valve arrhythmias from a femoral approach can be challenging. The valve leaflets often limit contact between the ablation catheter and the myocardial tissue.•In some patients with failed ablation attempts, successful arrhythmia elimination may be achieved by positioning the ablation catheter from below the tricuspid annulus, as opposed to the standard approach above the annulus. Intracardiac echocardiography (ICE) is essential in these cases to monitor for real-time catheter position.•For arrhythmias originating from the anterior tricuspid annulus we describe a novel ICE-guided technique involving the aid of a long sheath and a "double S" configuration on the ablation catheter.