Abstract | BACKGROUND: We 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 METHOD: This prospective, observational study enrolled 40 children (58% male children, median age of 13 years, and median weight of 47.5 kg) with Wolff-Parkinson-White syndrome. Conduction through the AP to a cycle length of ≤250 ms was considered rapid or high-risk; otherwise, patients were nonrapid or low-risk. RESULTS: The 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). CONCLUSION: Abrupt 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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Authors | Yakup Ergul, Erkut Ozturk, Isa Ozyilmaz, Serkan Unsal, Hayat Carus, Hasan Tahsin Tola, Ibrahim Cansaran Tanidir, Alper Guzeltas |
Journal | Congenital heart disease
(Congenit Heart Dis)
2015 Nov-Dec
Vol. 10
Issue 6
Pg. 542-51
ISSN: 1747-0803 [Electronic] United States |
PMID | 26010236
(Publication Type: Journal Article, Observational Study)
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Copyright | © 2015 Wiley Periodicals, Inc. |
Topics |
- Adolescent
- Child
- Electrocardiography
- Exercise Test
(statistics & numerical data)
- Female
- Heart Rate
(physiology)
- Humans
- Incidence
- Male
- Prospective Studies
- ROC Curve
- Risk Assessment
(methods)
- Risk Factors
- United States
(epidemiology)
- Wolff-Parkinson-White Syndrome
(diagnosis, epidemiology, physiopathology)
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