Efficacy and safety of the adenosine administration test in the management of Wolff-Parkinson-White pattern in children with delta waves.

Background: The Wolff-Parkinson-White pattern is a delta wave frequently detected in school-based cardiovascular screening programs in Japan. Although most children with Wolff-Parkinson-White pattern are asymptomatic, initial symptoms may include syncope or sudden death, necessitating accurate diagnosis and management. Delta waves can also indicate a fasciculoventricular pathway, which poses no risk and does not require management.

Methods: We reviewed the medical records of patients referred to our hospital between April 2008 and March 2022 to evaluate the electrocardiographic signs of the Wolff-Parkinson-White pattern. The existence of Wolff-Parkinson-White syndrome and fasciculoventricular pathway were determined based on atrioventricular block and QRS waveform changes after adenosine administration during sinus rhythm.

Results: The study cohort included 127 children (65 males; median age: 12.8 years, resting heart rate: 75 beats/min, PR interval: 109 ms, and QRS duration: 101 ms). The adenosine administration test revealed a fasciculoventricular pathway, Wolff-Parkinson-White syndrome, and indeterminate findings in 64, 54, and 9 children, respectively. More than 60% of children with a QRS duration ≤ 120 ms had a fasciculoventricular pathway. Age ≤ 12 years, QRS duration >120 ms, and type A category (children with R/S ratios >1 in lead V1) were identified as independent risk factors for Wolff-Parkinson-White syndrome. No adverse events were observed in any child.

Conclusions: The adenosine administration test is safe and feasible for differentiating Wolff-Parkinson-White syndrome from fasciculoventricular pathways and can reduce the unnecessary management of children with fasciculoventricular pathways.