Radiofrequency ablation is the primary approach for the treatment of patients with Wolff–Parkinson–White (WPW) syndrome. When the accessory pathways are located close to the coronary sinus or fibrous ring of the tricuspid or mitral valves, the endocardial radiofrequency ablation it is usually used. When patients have an epicardial or intramyocardial accessory pathways, the use of endocardial radiofrequency ablation might be not effective due to the difficult availability of the ablation catheter in the areas of the radiofrequency exposure zone. Accessory pathways located above or below the fibrous ring or coronary sinus are usually available for the endocardial catheter. When the accessory pathways (AP) is located at epicardial or intramyocardial, the use of endocardial radiofrequency ablation catheter maybe not effective due to the difficult accessibility of the radiofrequency exposure zone. Currently, several clinical trials on the use of epicardial access for radiofrequency ablation are described. In these patients, relapses occur more frequently, which requires additional surgery. The method of choice for this category of patients is the use of open methods for eliminating an AP. Previously applied the methods of surgical removal of AP that were used previously – Iwa operation, epicardial electro-impulse destruction, catheter electric impulse fulguration, laser destruction of AP. For this moment, cardio surgeons using methods of operations – operation Sealy, radiofrequency ablation, cryodestruction of an AP. of the operation technique, and at which location the AP compounds are most effective operation above. Thus, an individual approach to the choice of surgical elimination of accessory pathways is an actual problem, which will reduce the number of relapses and repeated exposures and postoperative complications.