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

Area of Science:

• Pediatric Cardiology
• Electrophysiology
• Diagnostic Testing

Background:

• The Wolff-Parkinson-White (WPW) pattern on electrocardiogram (ECG) can be challenging to diagnose, especially in pediatric patients.
• Adenosine challenge (AC) is a potential diagnostic tool, but its efficacy and safety in children require further investigation.

Purpose of the Study:

• To evaluate the efficacy and safety of adenosine challenge (AC) for diagnosing subtle Wolff-Parkinson-White (WPW) patterns in the pediatric population.
• To assess adverse events and outcomes associated with AC testing in children.

Main Methods:

• Retrospective review of 56 adenosine challenges (AC) performed between January 2009 and June 2017 in pediatric patients (n=51, median age 13.8 years).
• Analysis included patient demographics, adenosine dosing, AC results, adverse effects, and outcomes, including electrophysiology studies (EPS).
• Evaluation of ECG criteria for inter-rater reliability and correlation to positive AC results.

Main Results:

• Thirty-one (76%) pre-EPS AC tests were negative, 9 (22%) were positive, and 1 (2%) was equivocal. Fifteen post-EPS AC tests were all negative.
• Electrophysiology studies (EPS) following positive AC revealed accessory pathways (AP) in 71% left posterior and 29% right posteroseptal locations.
• No adverse events or documented arrhythmias were reported during or after AC testing, with a mean follow-up of 314 days.

Conclusions:

• Adenosine challenge (AC) is an effective and safe diagnostic modality for subtle Wolff-Parkinson-White (WPW) patterns in pediatric patients.
• The study demonstrated a favorable safety profile, with no adverse events or arrhythmias observed in pediatric patients following AC testing.