title: Differentiating fasciculoventricular pathway from Wolff-Parkinson-White syndrome by electrocardiography.
abstract: BACKGROUND
  In school-based cardiovascular screening programs in Japan, Wolff-Parkinson-White (WPW) syndrome is diagnosed based on the presence of an electrocardiographic (ECG) delta wave without differentiation from the fasciculoventricular pathway (FVP), although the risk of sudden death is associated only with the former.
  
  
  OBJECTIVE
  The purpose of this study was to differentiate FVP patients among children diagnosed with WPW syndrome by ECG.
  
  
  METHODS
  Children who were diagnosed with WPW syndrome through school screening between April 2006 and March 2008 and had QRS width ≤120 ms were included. Patients with asthma and/or coronary heart disease were excluded. FVP and WPW syndrome were differentiated based on ECG responses to adenosine triphosphate (ATP) injection. Age, PR interval, QRS width, and Rosenbaum classification were compared among patients.
  
  
  RESULTS
  Thirty patients (median age 12.7 years, range 6.5-15.7 years) participated in the study. FVP was diagnosed in 23 patients (76.7%), and WPW syndrome in 7 (23.3%). In Rosenbaum type A patients, all six patients had WPW syndrome, whereas FVP was diagnosed in 23 of 24 and WPW syndrome was diagnosed in 1 of 24 of type B patients. Age, PR interval, and QRS width were not significantly different between the two conditions.
  
  
  CONCLUSIONS
  ATP stress test was reliable in differentiating FVP from WPW syndrome. Although FVP is considered rare, the results of our study indicate that many WPW syndrome patients with QRS width ≤120 ms may actually have FVP. Patients categorized as type B are more likely to have FVP, whereas type A patients are most likely to have WPW syndrome.
authors.affiliation: Department of Pediatric Electrophysiology, Pediatric Medical Care Center, Osaka City General Hospital, Osaka, Japan. Electronic address: tsugutoshi@me.com.
authors.forename: Tsugutoshi
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Department of Pediatric Electrophysiology, Pediatric Medical Care Center, Osaka City General Hospital, Osaka, Japan.
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Nakamura
authors.affiliation: Department of Pediatric Electrophysiology, Pediatric Medical Care Center, Osaka City General Hospital, Osaka, Japan.
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Yoshida
authors.affiliation: Department of Pediatric Electrophysiology, Pediatric Medical Care Center, Osaka City General Hospital, Osaka, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Yoshida
authors.affiliation: Department of Pediatrics, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Haruo
authors.initials: H
authors.lastname: Shintaku
mesh_terms: D000255:Adenosine Triphosphate; D000293:Adolescent; D002648:Child; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000002:abnormalities*; D006801:Humans; D008297:Male; D012572:School Health Services; D014927:Wolff-Parkinson-White Syndrome / Q000175:diagnosis*
chemical_list: D000255:Adenosine Triphosphate
keywords: ATP stress testing; Atrioventricular pathway; Delta wave; Electrocardiogram; Fasciculoventricular pathway; Preexcitation syndrome; Wolff-Parkinson-White syndrome