Utility of Exercise Testing and Adenosine Response for Risk Assessment in Children with Wolff–Parkinson–White Syndrome
CONGENITAL HEART DISEASE(2015)
Abstract
BackgroundWe aimed to determine the correlation between noninvasive testing (exercise stress testing [EST] and adenosine responsiveness of accessory pathway [AP]) and invasive electrophysiology study (EPS) for assessment antegrade conduction of the AP in Wolff-Parkinson-White syndrome. Patients and MethodThis prospective, observational study enrolled 40 children (58% male children, median age of 13 years, and median weight of 47.5kg) with Wolff-Parkinson-White syndrome. Conduction through the AP to a cycle length of 250ms was considered rapid or high-risk; otherwise, patients were nonrapid or low-risk. ResultsThe sudden disappearance of the delta-wave was seen in 10 cases (25%) during EST. Accessory pathway was found to be high-risk in 13 cases (13/40, 32.5%) while the accessory path was identified as low-risk in 27 cases; however, six patients (15%) had blocked AP conduction with adenosine during EPS. Low-risk classification by EST alone to identify patients with nonrapid conduction in baseline EPS had a specificity of 93% and a positive predictive value of 90% (accuracy 54%). Blocked AP conduction with adenosine as a marker of nonrapid baseline AP conduction had a specificity of 93% and a positive predictive value of 84%. Finally, AP was adenosine nonresponsive in the majority of patients (28/30, 93%) with persistent delta-waves, 40% of those who had a sudden disappearance of delta-waves had an adenosine-responsive AP (P value: .028). ConclusionAbrupt loss of preexcitation during EST and blocked AP conduction with adenosine had high specificity and positive predictive value for nonrapid and low-risk antegrade conduction during baseline invasive EPS. Successful risk stratification of pediatric patients with Wolff-Parkinson-White is possible through the use of EST and the adenosine responsiveness of AP.
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Key words
Wolff-Parkinson-White Syndrome,Exercise Testing,Adenosine,Children
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