Key result
In patients ≤21 years with WPW, adenosine-sensitive accessory pathways were associated with a longer median local AV interval compared to adenosine-insensitive pathways (40.5 ms vs 32.0 ms, P=0.029).
Why the study?
Are local AV intervals of adenosine-sensitive accessory pathways different from those of adenosine-insensitive accessory pathways in pediatric patients with WPW?
Case-Control (n=42)
Are local AV intervals of adenosine-sensitive accessory pathways different from those of adenosine-insensitive accessory pathways in pediatric patients with WPW?
Adenosine-sensitive accessory pathways in WPW are associated with longer local AV intervals and lower SVT inducibility, suggesting adenosine response should be considered when selecting ablation targets.
Longer local AV intervals may identify adenosine-sensitive pathways in pediatric WPW; hypothesis-generating for ablation target selection.
BACKGROUND: Successful ablation sites in Wolff-Parkinson-White syndrome (WPW) are characterized by short atrioventricular (AV) intervals. Approximately 15% of patients with WPW have adenosine-sensitive accessory pathways (APs). We sought to determine if local AV intervals of adenosine-sensitive APs are different from those of adenosine-insensitive APs in patients with WPW. METHODS: Patients ≤21 years with WPW and adenosine-sensitive APs who underwent successful ablation over a 9-year period were included. Patients with WPW and adenosine-insensitive APs were matched by age and weight in a 1:2 case-control design. AP location, antegrade and retrograde conduction properties, supraventricular tachycardia (SVT) inducibility, local AV interval, interval from delta wave onset to local ventricular activation (del-V), and time to loss of preexcitation were reviewed. RESULTS: Fourteen patients with adenosine-sensitive APs and 28 with adenosine-insensitive APs were included. Patients with adenosine-sensitive APs had minimum 1:1 antegrade AP conduction at a longer median paced cycle length (380, interquartile range [IQR] 295 to 585 ms vs 290, IQR 250 to 330 ms, P = 0.046), were less likely to have inducible SVT (35.7% vs 75.0%, P = 0.035), and had a longer median local AV interval (40.5, IQR 30.8 to 58.3 ms vs 32.0, IQR 29.3 to 37.8 ms, P = 0.029) when compared to those with adenosine-insensitive APs. CONCLUSION: Patients with WPW and adenosine-sensitive APs have 1:1 antegrade AP conduction at longer cycle lengths, lower likelihood of SVT induction, and longer local AV intervals when compared to those with adenosine-insensitive APs. In patients with WPW, it may be important to consider adenosine response when selecting appropriate ablation targets.
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Beach et al. (2017) conducted a case-control in Wolff-Parkinson-White syndrome (WPW) (n=42). Adenosine-sensitive accessory pathways vs. Adenosine-insensitive accessory pathways was evaluated on median local AV interval (ms) (p=0.029). In patients ≤21 years with WPW, adenosine-sensitive accessory pathways were associated with a longer median local AV interval compared to adenosine-insensitive pathways (40.5 ms vs 32.0 ms, P=0.029).
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