Where is the ablation target for an accessory pathway?

• A. AV Annulus
• B. Interatrial Septum
• C. Lateral Mitral Annulus
• D. Pulmonary Vein Ostia

Answer: (A)

Ablation for an accessory pathway targets the site where the pathway inserts into the atrioventricular ring. These pathways connect atrial and ventricular muscle bypassing the AV node, so the effective place to interrupt them is the AV annulus surrounding the mitral and tricuspid valves. By delivering energy at this annular insertion, the abnormal conduction is eliminated while preserving normal AV nodal function. That’s why the AV annulus is the correct target: it encompasses the usual locations of accessory pathways on both the right and left sides. The interatrial septum isn’t the typical route for these pathways, and the pulmonary vein ostia are reserved for atrial fibrillation ablation, not accessory pathway elimination.