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©2013 UpToDate ® Print Email ACC/AHA guideline summary: Radiofrequency catheter ablation (RFA) of accessory pathways Class I - There is evidence and/or general agreement that RFA of accessory pathways should be performed in the following settings •  Patientswith symptomatic atrioventricular (AV) reentrant tachycardia that isdrug resistant or the patient is drug intolerant or does not desirelong-term drug therapy. •  Patients with atrial fibrillation (or other atrial tachyarrhythmia) and a rapid ventricular response via the accessory pathway when the tachycardia is drug resistant or the patient is drug intolerant or does not desire long-term drug therapy. Class IIa - The weight of evidence or opinion is in favor of benefit from RFA of accessory pathways should be performed in the following settings •  Patientswith AV reentrant tachycardia or atrial fibrillation with rapidventricular rates identified during electrophysiological study ofanother arrhythmia. •  Asymptomatic patients with ventricular preexcitation whose livelihood or profession, important activities, insurability, or mental well being or the public safety would be affected by spontaneous tachyarrhythmias or the presence of the ECG abnormality. •  Patients with atrial fibrillation and a controlled ventricular response via the accessory pathway. •  Patients with a family history of sudden cardiac death. Class III - There is evidence that RFA of accessory pathways is not useful and may be harmful in the following setting •  Patients who have accessory pathway-related arrhythmias that are responsive to drug therapy, well tolerated, and preferred by the patient to ablation. Data from Zipes, DP, DiMarco, JP, Gillette, PC, et al. ACC/AHA Guidelines for Clinical Intracardiac Electrophysiological and Catheter Ablation Procedures. A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on Clinical Intracardiac Electrophysiologic and Catheter Ablation Procedures) Developed in Collaboration With the North American Society of Pacing and Electrophysiology. J Am Coll Cardiol 1995; 26:555.