Utility of Exercise Testing and Adenosine Response for Risk Assessment in Children with Wolff-Parkinson-White Syndrome

Ergül, Yakup; Öztürk, Erkut; Özyılmaz, İsa; Ünsal, Serkan; Carus, Hayat; Tola, Hasan Tahsin; Öztürk, Erkut; Güzeltaş, Alper

doi:10.1111/chd.12270

Cited by 6 publications

(2 citation statements)

References 24 publications

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“…One of our patients in the group with an additional accessory pathway did not respond with adenosine. Ergül et al 17 evaluated 40 children with WPW in their study, 6 patients responded to adenosine and one of them was in the high-risk group (13 high risk, 27 low risks). The use of adenosine alone is controversial, since adenosine response may also be in high-risk groups.…”

Section: Discussionmentioning

confidence: 99%

Electrocardiographic and electrophysiological characteristics of fasciculoventricular fibers in children

Sülü

Kafalı

Şahin

2022

Pacing Clinical Electrophis

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Objectives Fasciculoventricular fiber (FVF) that does not cause tachyarrhythmia is a rare form of ventricular preexcitation, which is important to distinguish from Kent fibers. Although, adenosine and some electrocardiographic features are important in the differentiation of Wolff Parkinson White (WPW) than FVF, a clear distinction may not always be possible without an electrophysiological study (EPS). In this study, we aimed to present the clinical and electrophysiological features of our pediatric patients with fasciculoventricular fiber. Patients and method Between October 2013 and September 2021, 565 patients who underwent electrophysiological studies due to ventricular preexcitation in our clinic were screened in the study, and 27 (4.7%) patients with fasciculoventricular fiber were included. The data of the patients were obtained from the file records using the electronic internet database system Filemaker®. Electrophysiological study age, weight, gender, symptom, and presence of congenital heart disease of the patients were obtained from the file records. Accessory pathway localization was evaluated according to the modified Arruda algorithm in pre‐procedural electrocardiography. In addition, delta wave amplitudes were measured in the first 40 ms from the surface ECG. PR interval, QRS interval, and delta wave amplitude were recorded before and after ablation in patients with additional accessory pathways. Post‐procedure values were included in the FVF group. Results The mean age of the patients was 11.47 ± 4.25 years. All 70.4% of the reasons for admission were symptoms such as palpitations and syncope. Two patients had hypertrophic cardiomyopathy and 1 patient had ccTGA. In the electrophysiological study, additional manifest WPW was found in 9 (33%) patients (3 patients with high risk, 6 patients with orthodromic supraventricular tachycardia), focal atrial tachycardia in a patient, and atrioventricular nodal reentry tachycardia in a patient. While the delta wave amplitude was found to be 2.56 ± 1.38(1–5.5) mm in the first 40 ms in surface electrocardiography in 9 patients with additional accessory pathway, it was found to be 1.64 ± 0.67(0.5–3) mm in the FVF group. There was no statistically significant difference between the 2 groups (p = .398). Delta wave amplitude > 3.5 mm was not detected in any patient with isolated FVF. Interestingly, delta wave amplitude was < 3.5 mm in 7 (78%) of 9 patients who were identified and ablated with an additional accessory pathway. Total 19 of the patients (59.3%) were adenosine‐responsive (18 isolated FVF, 1 manifest AP+FVF adenosine‐responsive. 8 patients with other manifest AP + FVF had no pre‐procedural adenosine‐asystole response, and all of them QRS were expanded). Conclusion Although, the fasciculoventricular fibers themselves are not the cause of tachyarrhythmia, the accessory pathway and other tachyarrhythmia substrate frequency accompanying these cases are quite high (approximately 40%) in EPS. The delta wave characteristics of ablated patients are ver...

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Section: Discussionmentioning

confidence: 99%

Electrocardiographic and electrophysiological characteristics of fasciculoventricular fibers in children

Sülü

Kafalı

Şahin

2022

Pacing Clinical Electrophis

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“…9 There has been little published regarding the safety and efficacy of AC in the pediatric population with potential accessory pathways (APs), however, despite its common use. [10][11][12] Because of the uncommon, but documented risk of atrial fibrillation (AF) induction with adenosine administration, some providers remain hesitant to perform AC for concerns of potential rapid antegrade conduction of AF across the AP. 13,14 The largest study to date was recently published in 2014 including 30 patients by Suzuki et al 15 evaluating the utility of AC for the differentiation of typical atrioventricular AP in Wolff-Parkinson-White (WPW) syndrome from fasciculoventricular pathways.…”

Section: Introductionmentioning

confidence: 99%

Utility and safety of adenosine challenge for subtle ventricular pre‐excitation in the pediatric population

Follansbee

Beerman

et al. 2019

Cardiovasc electrophysiol

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Introduction: Adenosine challenge (AC) can be used to evaluate possible Wolff-Parkinson-White (WPW) pattern on an electrocardiogram (ECG). Despite the use of this technique, there is a paucity of studies in the pediatric population evaluating the efficacy, safety, and outcomes of this testing modality. retrospectively reviewed. Patient demographics, adenosine dosing, results, adverse effects, and outcomes including results of electrophysiology studies (EPS) were reviewed. Analysis was conducted between AC positive and negative cohorts. ECG criteria of shortest PR interval, longest QRS duration, and the number of suspected pre-excited leads were evaluated for inter-rater reliability and correlation to positive AC. Fifty-six AC (n = 51) were performed (median age, 13.8; range, 0.3-20 years).Forty-one AC were pre-EPS and 15 post-EPS due to concern for recurrent WPW.Thirty-one (76%) pre-EPS AC were negative, 9 (22%) positive, and 1 (2%) equivocal.EPS was performed following seven positive AC revealing 5 (71%) left posterior and 2 (29%) right posteroseptal AP. The 15 post-EPS AC were all found to be negative.Mean effective adenosine dose was 0.2 ± 0.11 mg/kg. No adverse events were reported. Mean follow up duration after AC was 314 ± 482 days with no documented arrhythmias.Conclusion: Adenosine challenge is an effective and safe testing modality for subtle WPW in the pediatric population. In our population, there were no adverse events or documented arrhythmias in patients following a negative study. K E Y W O R D Sadenosine challenge, pediatrics, ventricular pre-excitation, Wolff-Parkinson-White

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Specific Populations: Paediatric and Adolescent Athletes

Pieles

Maxwell²,

Oberhoffer

2020

Textbook of Sports and Exercise Cardiology

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Utility of Exercise Testing and Adenosine Response for Risk Assessment in Children with Wolff-Parkinson-White Syndrome

Cited by 6 publications

References 24 publications

Electrocardiographic and electrophysiological characteristics of fasciculoventricular fibers in children

Electrocardiographic and electrophysiological characteristics of fasciculoventricular fibers in children

Utility and safety of adenosine challenge for subtle ventricular pre‐excitation in the pediatric population

Specific Populations: Paediatric and Adolescent Athletes

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