Background Adenosine is used as a diagnostic tool during electrophysiology studies to transiently block atrioventricular node (AVN) conduction. Persistence of VA conduction after adenosine administration is often interpreted as evidence of accessory pathway conduction. Studies in adults have shown that adenosine effect on retrograde AVN conduction is heterogeneous and there may be differing responses in those with dual AVN physiology. Objectives Our objective was to evaluate these phenomena in pediatric patients. Specifically, our goal was to assess retrograde AVN response to adenosine in pediatric patients. Methods We evaluated retrograde AVN response to adenosine in pediatric patients undergoing an electrophysiology study for supraventricular tachycardia or ventricular pre-excitation. Patients aged 4–25 years received intravenous adenosine (0.2 mg/kg, maximum 18 mg) during ventricular overdrive pacing. Results Of 58 analyzed patients, 30 had dual AVN physiology. Adenosine administration resulted in complete retrograde AVN block in 50% of patients with dual AVN physiology compared to 82% of those without dual AVN physiology (p = 0.01). Conclusion In children, continued retrograde AVN conduction after adenosine does not reliably indicate accessory pathway presence and does not rule out dual AVN physiology as the mechanism of tachycardia.
Background Pediatric hypertension has emerged as an increasingly prevalent public health challenge driven by rising childhood obesity, adverse perinatal exposures, metabolic dysfunction, and improved recognition. Elevated blood pressure (BP) during childhood is associated with early hypertension-mediated organ damage (HMOD) and strongly predicts adult hypertension and premature cardiovascular (CV) disease, highlighting the need for timely diagnosis, standardized evaluation, and lifelong risk reduction. Aim of review To provide a contemporary, clinically oriented review of pediatric hypertension by integrating recent evidence with recommendations from major pediatric and adult hypertension guidelines. This review emphasizes practical approaches to diagnosis, ambulatory BP monitoring (ABPM), risk stratification, differences across age spectrum, evaluation for secondary causes, hypertension-mediated organ damage, pharmacologic and non-pharmacologic management, and the transition from pediatric to adult CV care. Key scientific concepts of review Current pediatric hypertension management continues to rely on age-, sex-, and height-specific BP percentiles in children younger than 13 years, whereas adolescents increasingly adopt fixed adult thresholds, facilitating continuity of care. ABPM has become the preferred method for confirming hypertension, identifying white-coat and masked hypertension, assessing circadian BP patterns, and improving cardiovascular risk stratification. Management should follow a stepwise, individualized approach beginning with lifestyle modification and progressing, when indicated, to guideline-directed pharmacotherapy using angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, long-acting calcium channel blockers, and/or thiazide diuretics. This review also presents practical diagnostic algorithms, summarizes current referral pathways and evaluation strategies, and discusses emerging advances, including telemedicine, wearable BP technologies, artificial intelligence, and precision medicine that are likely to reshape future pediatric hypertension care. Early recognition, harmonized management across the pediatric-adult continuum, and multidisciplinary care remain essential to reducing HMOD and preventing lifelong CV disease.
