title: Utility of Exercise Testing and Adenosine Response for Risk Assessment in Children with Wolff-Parkinson-White Syndrome.
abstract: BACKGROUND
  We aimed to determine the correlation between noninvasive testing (exercise stress testing [EST] and adenosine responsiveness of accessory pathway [AP] ) and invasive electrophysiology study (EPS) for assessment antegrade conduction of the AP in Wolff-Parkinson-White syndrome.
  
  
  METHODS
  This prospective, observational study enrolled 40 children (58% male children, median age of 13 years, and median weight of 47.5 kg) with Wolff-Parkinson-White syndrome. Conduction through the AP to a cycle length of ≤250 ms was considered rapid or high-risk; otherwise, patients were nonrapid or low-risk.
  
  
  RESULTS
  The sudden disappearance of the delta-wave was seen in 10 cases (25%) during EST. Accessory pathway was found to be high-risk in 13 cases (13/40, 32.5%) while the accessory path was identified as low-risk in 27 cases; however, six patients (15%) had blocked AP conduction with adenosine during EPS. Low-risk classification by EST alone to identify patients with nonrapid conduction in baseline EPS had a specificity of 93% and a positive predictive value of 90% (accuracy 54%). Blocked AP conduction with adenosine as a marker of nonrapid baseline AP conduction had a specificity of 93% and a positive predictive value of 84%. Finally, AP was adenosine nonresponsive in the majority of patients (28/30, 93%) with persistent delta-waves, 40% of those who had a sudden disappearance of delta-waves had an adenosine-responsive AP (P value: .028).
  
  
  CONCLUSIONS
  Abrupt loss of preexcitation during EST and blocked AP conduction with adenosine had high specificity and positive predictive value for nonrapid and low-risk antegrade conduction during baseline invasive EPS. Successful risk stratification of pediatric patients with Wolff-Parkinson-White is possible through the use of EST and the adenosine responsiveness of AP.
authors.affiliation: Department of Pediatric Cardiology, İstanbul Mehmet Akif Ersoy, Thoracic and Cardiovascular Surgery Center and Research Hospital, Istanbul, Turkey.
authors.forename: Yakup
authors.initials: Y
authors.lastname: Ergul
authors.affiliation: Department of Pediatric Cardiology, İstanbul Mehmet Akif Ersoy, Thoracic and Cardiovascular Surgery Center and Research Hospital, Istanbul, Turkey.
authors.forename: Erkut
authors.initials: E
authors.lastname: Ozturk
authors.affiliation: Department of Pediatric Cardiology, İstanbul Mehmet Akif Ersoy, Thoracic and Cardiovascular Surgery Center and Research Hospital, Istanbul, Turkey.
authors.forename: Isa
authors.initials: I
authors.lastname: Ozyilmaz
authors.affiliation: Department of Anesthesiology, İstanbul Mehmet Akif Ersoy, Thoracic and Cardiovascular Surgery Center and Research Hospital, Istanbul, Turkey.
authors.forename: Serkan
authors.initials: S
authors.lastname: Unsal
authors.affiliation: Department of Anesthesiology, İstanbul Mehmet Akif Ersoy, Thoracic and Cardiovascular Surgery Center and Research Hospital, Istanbul, Turkey.
authors.forename: Hayat
authors.initials: H
authors.lastname: Carus
authors.affiliation: Department of Pediatric Cardiology, İstanbul Mehmet Akif Ersoy, Thoracic and Cardiovascular Surgery Center and Research Hospital, Istanbul, Turkey.
authors.forename: Hasan Tahsin
authors.initials: HT
authors.lastname: Tola
authors.affiliation: Department of Pediatric Cardiology, İstanbul Mehmet Akif Ersoy, Thoracic and Cardiovascular Surgery Center and Research Hospital, Istanbul, Turkey.
authors.forename: Ibrahim Cansaran
authors.initials: IC
authors.lastname: Tanidir
authors.affiliation: Department of Pediatric Cardiology, İstanbul Mehmet Akif Ersoy, Thoracic and Cardiovascular Surgery Center and Research Hospital, Istanbul, Turkey.
authors.forename: Alper
authors.initials: A
authors.lastname: Guzeltas
mesh_terms: D000293:Adolescent; D002648:Child; D004562:Electrocardiography; D005080:Exercise Test / Q000706:statistics & numerical data*; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D015994:Incidence; D008297:Male; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014927:Wolff-Parkinson-White Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology
keywords: Adenosine; Children; Exercise Testing; Wolff-Parkinson-White Syndrome