Division of Pediatric Cardiology, Department of Pediatrics, Morgan Stanley Children's Hospital, New York Presbyterian Hospital, 3959 Broadway, 2 North, New York, NY, 10032, USA.
Pediatr Cardiol. 2021 Aug;42(6):1350-1355. doi: 10.1007/s00246-021-02618-w. Epub 2021 Apr 23.
Block in accessory pathway (AP) conduction with adenosine has been previously described. However, conduction characteristics of these APs has not been well defined to date. All patients with APs </ = 21 years old who underwent an EP study from 2014 to 2017 were included in our study. Patients with adenosine sensitive APs were identified (group 1). Demographic and AP conduction characteristics were compared between group 1 and the entire cohort of patients. Local atrioventricular (AV) or ventriculoatrial (VA) time, cycle length and need for isoproterenol were compared to a control group matched by age and AP location (group 2). Student's t test, Wilcoxon rank sum, χ and Fisher's exact were used for analysis. Fourteen (7%) out of 207 patients had an adenosine sensitive AP. The median age of patients with adenosine sensitive APs was 11.8 (IQR 8.5-13.5) years vs. 14 (IQR 10.6-16.7) for the rest of the cohort (p = 0.04). Three of the 134 patients with preexcitation had adenosine sensitive APs (2%) vs. 11 of the 73 patients with concealed APs (15%) (p = 0.001). The median local AV/VA time at the site of successful ablation was longer in group 1 vs group 2 [78 ms, IQR 62-116 vs. 31 ms, IQR 30-38; p < 0.001]. Antegrade AP effective refractory period and total procedure time were longer in patients with adenosine sensitive APs (p = 0.03 & p = 0.04, respectively). Adenosine sensitive APs which occur in children are more often concealed. These APs have a longer conduction time at the site of successful ablation.
已有研究描述了在旁道（AP）传导中应用腺苷进行阻滞。然而，这些 AP 的传导特性至今尚未得到很好的定义。本研究纳入了 2014 年至 2017 年期间进行电生理检查的所有年龄≤21 岁的 AP 患者。确定腺苷敏感 AP 患者（组 1）。比较组 1 与整个患者队列的人口统计学和 AP 传导特征。比较局部房室（AV）或室房（VA）时间、心动周期长度和异丙肾上腺素的需要，与年龄和 AP 位置匹配的对照组（组 2）。使用学生 t 检验、Wilcoxon 秩和检验、χ 检验和 Fisher 确切检验进行分析。207 例患者中有 14 例（7%）存在腺苷敏感 AP。腺苷敏感 AP 患者的中位年龄为 11.8（IQR 8.5-13.5）岁，而其余队列的中位年龄为 14（IQR 10.6-16.7）岁（p=0.04）。134 例预激患者中有 3 例（2%）存在腺苷敏感 AP，73 例隐匿性 AP 患者中有 11 例（15%）（p=0.001）。在成功消融部位，组 1 的局部 AV/VA 时间中位数较长[78ms，IQR 62-116 与 31ms，IQR 30-38；p<0.001]。腺苷敏感 AP 患者的逆行 AP 有效不应期和总手术时间较长（p=0.03 和 p=0.04）。在儿童中发生的腺苷敏感 AP 更常为隐匿性。这些 AP 在成功消融部位的传导时间较长。
