Background The radiofrequency ablation of overt AV accessory pathway in 20 cases of PWP syndrome patients with atrial fibrillation (AF) was summarized.Methods Of 20 patients, left side accessory pathway was found in 11 cases, right side in 9 cases.17 cases have a history of paroxysmal atrial fibrillation.The ventricular rate of accessory pathway anterior conducting in atrial fibrillation patients is (173±30) (138-240) beats/minute.The left side accessory pathway was ablated through aortic retrograde approach and the right side through femoral vein approach, aiming the earliest ventricular activation and a small A wave point as the ablation target.