The risk of residential overheating and mortality is increasing due to the effects of global warming and the urban heat island effect and needs to be addressed through climate change adaptation. ‘Adaptation pathways’ have become widely recognised as an adaptation planning approach, but they have not been utilised for long-term planning for city-scale urban heat risk management. This paper applies adaptation pathway methodology to urban heat risk management. We use spatially coherent downscaled probabilistic climate change projections that account for changes in urban-land cover and the urban heat island to appraise adaptation pathways and inform long-term adaptation planning. We demonstrate that adaptation strategies focusing solely on urban greening or building level adaptation based on current best practice are unlikely to cope with the increasing levels of risk. Air-conditioning may play a growing role in managing heat-risk; however, increasing air-conditioning will exacerbate the urban heat island and further increase the risks of overheating.