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Significance of Wedensky Modulation testing in the evaluation of non-invasive risk stratification for ventricular tachyarrhythmia in patients with coronary artery disease and implantable cardioverter/defibrillator
  1. Nesrin Elgarhi (n.elgarhi{at}web.de)
  1. Department of Medicine - Cardiology, University of Bonn, Germany
    1. Jens Kreuz
    1. Department of Medicine - Cardiology, University of Bonn, Germany
      1. Osman Balta
      1. Department of Medicine - Cardiology, University of Bonn, Germany
        1. Georg Nickenig
        1. Department of Medicine - Cardiology, University of Bonn, Germany
          1. Harold Hoium
          1. Harbinger Medical Inc., United States
            1. Thorsten Lewalter
            1. Department of Medicine - Cardiology, University of Bonn, Germany
              1. Joerg O Schwab (joerg.schwab{at}ukb.uni-bonn.de)
              1. Department of Medicine - Cardiology, University of Bonn, Germany

                Abstract

                Objective of the significance of the Wedensky Modulation (WM) exam for ventricular tachyarrhythmias (VT) in patients with coronary artery disease and implantable cardioverter-defibrillator therapy (ICD).

                Design Prospective, mono-center study conducted from 2004-2006

                Setting University of Bonn, Department of Medicine-Cardiology, Bonn, Germany.

                Patients 37 consecutive patients with coronary artery disease receiving an ICD for primary or secondary prevention. Main outcome measures: Correlation of a positive WM-Index (WMI) to established non invasive Holter parameter, the occurrence of VT after ICD implantation with regard to primary or secondary prevention, and inducibiliy of VT during electrophysiological (EP) studies.

                Results The WMI was positive in 15 patients (67 ± 8 years, 31 ± 12 % EF) and showed significant correlation to heart rate variability (SDNN: p=0.04, r=0,45; TP: p=0.03, r=0,384; VLF: p=0.03; LF: p=0.05, r=0,375; HF: p=0.05, r=0,315) and turbulence (TO: p=0.05, r=0,301; TS: p=0.04, r=0,419). The positive predictive value of the WMI considering the inducibility of VT during EP testing was 100 %. Those patients who received an ICD for primary prevention, showed a higher WMI (p=0.049), compared to the group of secondary prevention. With respect to the occurrence of adequate VT episodes, a negative WM test result demonstrated a negative predictive value of 95 %.

                Conclusion The data presented shows that the WM-Index predicts VT inducibility during EP testing and indicates a high negative predictive value regarding the occurrence of VT.

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