Atrioventricular accessory pathways are characterized by rapid non-decremental conduction from the atria to the ventricles. Following catheter ablation, conduction through the accessory route disappears completely. However, few case reports described decremental antegrade accessory pathway conduction after radiofrequency ablation as a result of insufficient thermal effect at the ablation site. We present the case of a 70-year-old female patient with a left posterior accessory pathway that acquired decremental retrograde conduction after insufficient catheter ablation. We repeated radiofrequency applications until we attained full ablation accompanied by the loss of retrograde decremental conduction in its totality.
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