Unmasking accessory pathway conduction with adenosine-induced atrioventricular nodal block after radiofrequency catheter ablation

Radiofrequency catheter ablation is very effective in eliminating conduction over accessory pathways in patients with Wolff-Parkinson-White syndrome. However, accessory pathway conduction recurs in approximately 5 to 9 percent of patients in the weeks to months following ablation. We describe two cases in which intravenous adenosine revealed persistent accessory pathway conduction after apparently successful ablation, thus providing an indication for the delivery of further ablative therapy. Adenosine may improve the long-term efficacy of radiofrequency catheter ablation of accessory pathways by manifesting latent accessory pathway conduction.