Kogawa Kentaro, Ito Reiji, Hirano Daishi, Hoshino Kenji
Saitama Children's Medical Center, Division of Pediatric Cardiology, Saitama, Japan.
Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan.
Cardiol Young. 2025 Jan;35(1):46-52. doi: 10.1017/S104795112403659X. Epub 2025 Jan 8.
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.
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.
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.
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.
预激综合征（Wolff-Parkinson-White pattern）是一种在日本学校心血管筛查项目中经常检测到的δ波。虽然大多数患有预激综合征的儿童没有症状，但初始症状可能包括晕厥或猝死，因此需要准确的诊断和管理。δ波也可能提示分支室性通路，这种情况没有风险，不需要进行管理。
我们回顾了2008年4月至2022年3月转诊至我院的患者的病历，以评估预激综合征的心电图表现。根据窦性心律时腺苷给药后的房室传导阻滞和QRS波形变化来确定预激综合征和分支室性通路的存在。
研究队列包括127名儿童（65名男性；中位年龄：12.8岁，静息心率：75次/分钟，PR间期：109毫秒，QRS时限：101毫秒）。腺苷给药试验分别在64名、54名和9名儿童中发现了分支室性通路、预激综合征和不确定结果。QRS时限≤120毫秒的儿童中，超过60%有分支室性通路。年龄≤12岁、QRS时限>120毫秒和A型（V1导联R/S比值>1的儿童）被确定为预激综合征的独立危险因素。未观察到任何儿童出现不良事件。
腺苷给药试验对于区分预激综合征和分支室性通路是安全可行的，可以减少对有分支室性通路儿童的不必要管理。
