The role of the adenosine test in preventing early recurrence after atrioventricular accessory pathway ablation in children

Background Radiofrequency ablation of atrioventricular accessory pathways (AP) is highly effective in pediatric patients with Wolff–Parkinson–White syndrome or concealed APs. Despite procedural success, early recurrence may occur due to latent conduction. The adenosine test can unmask residual or concealed conduction, potentially allowing earlier termination of the procedure without the conventional 30-minute post-ablation observation. Objective This study evaluated the role of the adenosine test in detecting latent AP conduction following apparently successful ablation in children and assessed whether adenosine administration could substitute the traditional observation period. Methods A prospective cohort of 52 pediatric patients undergoing successful AP ablation was studied. Adenosine was administered 5–10 minutes post-ablation after electrophysiologic confirmation of AP block. Transient adenosine-induced conduction prompted immediate additional ablation until the test became negative. Early recurrence was monitored via surface ECG 30–60 minutes post-procedure and at a 6-week follow-up. The incidence of adenosine-induced latent conduction and recurrence was analyzed. Logistic regression was used to calculate odds ratios (OR) for 6-week recurrence. Results Latent AP conduction was detected in 7/52 patients (13%) by the adenosine test. No significant difference was observed between overt and concealed APs among adenosine-positive cases (p=0.347). Only one patient experienced a 30-minute recurrence among overt pathways. At 6 weeks, recurrence was 7.5-fold higher in adenosine-positive patients compared to adenosine-negative patients (OR 7.52, 95% CI 0.95–59.69, p=0.056). AP localization also showed trends toward increased recurrence: right-sided pathways (OR 6.24, 95% CI 0.69–56.10, p=0.102) and septal pathways (OR 4.71, 95% CI 0.64–34.83, p=0.129). No significant associations were found with sex or underlying diagnosis. Conclusions The adenosine test effectively identifies latent AP conduction after pediatric ablation and may predict higher recurrence risk. Although it can potentially replace the 30-minute observation period, borderline increased 6-week recurrence in adenosine-positive and certain pathway localizations suggests that careful post-procedural follow-up remains essential.