Introduction Radiofrequency (RF) ablation of parahisian accessory pathways (PHAPs) is a serious challenge, which is associated with high recurrence and fluoroscopy exposure. According to previous studies and case reports, catheter ablation of PHAPs is associated with a high post-ablation recurrence. The aim of this study is to assess the efficacy, safety and long-term outcome of radiofrequency ablation in patients with recurrent PHAPs after prior ablations with zero or extremely low fluoroscopy. Methods and Results A total of 58 patients (43 male, 75.4%) with PHAPs that had one or more previously unsuccessful RF ablations were enrolled. RF ablation procedures were performed under a three-dimensional guiding system (EnSite NavX, St. Jude Medical, MN) with extremely low exposure of fluoroscopy to femoral venous or arterial routes. The acute success rate was 96.6% (56/58). Two procedures were terminated during ablation because of high risk of complete AVB. In addition to a case of transient complete AVB during RF energy delivery, no minor or major complications were recorded during the procedure or long-term follow up. The mean fluoroscopy time was 98 seconds (0-129), and the mean radiation dose was 1.98 mGy (0-3.38) in all 58 cases. Fourteen patients underwent the EPS and RF ablation with zero X-ray exposure. The long-term success rate was 98.2% with a median follow-up period of 30 (12-45) months. Conclusions With a near zero X-ray exposure, RF ablation of recurrent PHAPs can be performed with a high acute success rate and convincing safety during long-term follow-up.