Key result
IV adenosine yields a ~39% lower rate of complete retrograde block in dual AVN physiology.
Why the study?
Adult studies show heterogeneous retrograde AVN responses to adenosine, but whether these phenomena occur in pediatric patients was unknown.
Does intravenous adenosine reliably cause complete retrograde AVN block in pediatric and young adult patients with dual AVN physiology?
Observational (n=58)
Does intravenous adenosine reliably cause complete retrograde AVN block in pediatric and young adult patients with dual AVN physiology?
Absolute Event Rate: 50% vs 82%
p-value: p=0.01
In pediatric and young adult patients, continued retrograde AVN conduction after adenosine administration does not reliably indicate the presence of an accessory pathway, particularly in those with dual AVN physiology.
May inform adenosine interpretation during pediatric EP studies; leaves open whether adult heterogeneity extends to children.
Background Adenosine is used as a diagnostic tool during electrophysiology studies to transiently block atrioventricular node (AVN) conduction. Persistence of VA conduction after adenosine administration is often interpreted as evidence of accessory pathway conduction. Studies in adults have shown that adenosine effect on retrograde AVN conduction is heterogeneous and there may be differing responses in those with dual AVN physiology. Objectives Our objective was to evaluate these phenomena in pediatric patients. Specifically, our goal was to assess retrograde AVN response to adenosine in pediatric patients. Methods We evaluated retrograde AVN response to adenosine in pediatric patients undergoing an electrophysiology study for supraventricular tachycardia or ventricular pre-excitation. Patients aged 4–25 years received intravenous adenosine (0.2 mg/kg, maximum 18 mg) during ventricular overdrive pacing. Results Of 58 analyzed patients, 30 had dual AVN physiology. Adenosine administration resulted in complete retrograde AVN block in 50% of patients with dual AVN physiology compared to 82% of those without dual AVN physiology ( p = 0.01). Conclusion In children, continued retrograde AVN conduction after adenosine does not reliably indicate accessory pathway presence and does not rule out dual AVN physiology as the mechanism of tachycardia.
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Pompa et al. (2026) conducted an observational in Supraventricular tachycardia or ventricular pre-excitation (n=58). Intravenous adenosine vs. Patients without dual AVN physiology was evaluated on Complete retrograde AVN block (p=0.01). Intravenous adenosine resulted in complete retrograde AVN block in 50% of patients with dual AVN physiology compared to 82% of those without dual AVN physiology (p=0.01).
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