”Pre-excitation” sounds very abstract, but in fact it is simply the growth of an extra “path” (bypass) in the heart to conduct electrical activity. This is the result of a “slight short circuit”. The percentage of people with “pre-excitation” is about 0.1-0.3% of the general population. Patients often ask in the clinic why some patients are recommended to undergo radiofrequency ablation (a minimally invasive catheter intervention that can cure the disease) and some are not. The potential risk of “pre-excitation” is the initiation or involvement of tachycardia (short-circuiting of the heart’s electrical current), mostly paroxysmal supraventricular tachycardia (which is generally not fatal but can recur over the years and tends to be more frequent with age). The majority are paroxysmal supraventricular tachycardias (which are generally not fatal but can recur over the years and tend to be more frequent with age), and a minority of patients develop tachyarrhythmias that cause severe symptoms and carry the risk of fatal ventricular fibrillation or even sudden death. Therefore, if a patient has paroxysmal palpitations, panic attacks, or rapid heartbeat, especially if the ECG confirms an episode of tachycardia, which is called “pre-excitation syndrome”, radiofrequency ablation is clinically recommended for this type of patient. If the ECG shows “pre-excitation”, but the patient has never had any suspicious symptoms such as tachycardia attack or syncope, it is called “asymptomatic pre-excitation”, which is mostly seen in adolescents and middle-aged people. In cases where tachycardia has not yet occurred, how should it be managed and is it necessary to “pre-emptively” perform radiofrequency ablation to prevent its onset later? In recent years, the medical community has become increasingly concerned about this issue. It is now generally accepted that a patient-specific analysis should be made to fully weigh the pros and cons. It is recommended that patients with asymptomatic pre-excitation may wish to take the following approach. Have a cardiac ultrasound to find out if there are any structural abnormalities in the heart, and it is best if there are none. If the ECG is “intermittent preexcitation” (i.e., the preexcitation is sometimes present and sometimes absent on the same ECG), most of them are “low risk” and can be temporarily excluded from RF ablation. Regular follow-up by cardiologist. If the preexcitation disappears during exercise (about 10% of patients), the patient is likely to be “low risk” and can be followed up regularly according to the previous method. If the preexcitation during exercise does not disappear, this does not mean that this group of patients is at high risk. Further consideration of transesophageal pacing electrophysiology or intracardiac electrophysiology is recommended. Among them, intracardiac electrophysiological examination is a minimally invasive and invasive examination with high accuracy, but it requires hospitalization. It is a mandatory stage of radiofrequency ablation and can be done on the same stage as the ablation procedure. Based on the results of the above electrophysiological examination, the characteristics of the “pre-excited” bypass, the “ability” to cause disease and the “level” of ability (i.e. the level of risk) are determined, and then combined with the patient’s Then, we will determine the advantages and disadvantages of ablation, and decide the next treatment strategy, taking into account the patient’s characteristics (age, the need for RF ablation, etc.) and the location of the bypass (the ease of RF ablation). If ablation is temporarily not performed, close follow-up should also be performed to note any suspicious symptoms. It should be emphasized that some patients may eventually develop tachycardia and require radiofrequency ablation.