Key result
IV adenosine testing identifies a benign FVP, allowing an athlete unrestricted sports without contraindicated ablation.
Why the study?
Ventricular pre-excitation in competitive athletes requires careful evaluation, as fasciculoventricular pathways are a rare, benign subtype that must be distinguished from higher-risk pathways.
Case Report (n=1)
Adenosine testing can noninvasively differentiate benign fasciculoventricular pathways from higher-risk accessory pathways in athletes, preventing contraindicated ablation and allowing safe return to play.
Supports conservative management without ablation for confirmed FVPs in athletes; leaves open need for larger studies to guide pre-excitation screening.
BACKGROUND: Ventricular pre-excitation in competitive athletes requires careful evaluation as not all accessory pathways carry equal risk. Fasciculoventricular pathways (FVPs) are a rare, benign subtype that should be distinguished from higher-risk pathways. CASE SUMMARY: A 21-year-old asymptomatic male collegiate cross-country athlete was found to have a ventricular pre-excitation pattern on routine screening electrocardiogram. An electrophysiology study revealed a shortened His-ventricular interval with a fixed pre-excitation pattern during atrial pacing. Intravenous adenosine produced a transient atrioventricular block with a fixed pre-excitation pattern, confirming a benign FVP. No ablation was performed. DISCUSSION: FVPs represent less than 1% of cases of pre-excitation patterns and carry no risk of sudden cardiac death. Ablation is contraindicated (Class III: Harm) because of the risk of complete atrioventricular block. Adenosine testing can noninvasively differentiate FVPs from higher risk pathways. TAKE-HOME MESSAGES: Accurate characterization of accessory pathways is critical. Athletes with FVPs may continue unrestricted sports participation without ablation.
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Katamreddy et al. (2026) conducted a case report in Ventricular pre-excitation (n=1). Intravenous adenosine testing was evaluated. Intravenous adenosine testing identified a benign fasciculoventricular pathway in a 21-year-old athlete, allowing unrestricted sports participation without contraindicated ablation.
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