The Wedensky test predicts malignant ventricular arrhythmias after myocardial infarction

Abstract

Objectives. Better tools are needed for detection of future malignant ventricular arrhythmias post myocardial infarct (MI). Wedensky Modulation (WM) is a new semi-invasive method: A short low-amplitude electrical impulse is applied synchronized to the QRS between a precordial and dorsal thoracic patch, and changes in the following QRS-T are registered. Design. A total of 357 (MI) ICD patients underwent WM testing. QRS-T wavelet analysis provided WM Indexes for the QRS complex (WMI-R) and T wave (WMI-T). Outcome was the time to first occurrence of appropriate device therapy for ventricular arrhythmia. Patients were followed at 6-month intervals for 2 years. Results. No arrhythmia was induced by the testing. Two-year appropriate arrhythmia treatment occurred in 35% (WMI-R positive) versus 25% (WMI-R negative, p = 0.014), and. 45% versus 26% (p = 0.001) for WMI-T positive versus negative. Two-year event rates of WMI-R or WMI-T positive versus WMI-R and WMI-T negative were 36% versus 22% (p = 0.004). In Cox proportional hazard model, the combination of WMI-R and WMI-T was the only statistically significant event predictor (p = 0.003). Conclusion. Potentially life-threatening ventricular arrhythmic events could be predicted by the WM test. In combination with other risk factors WMI may be useful in these patients.

Key words::

• arrhythmias
• diagnostic
• Wedensky
• sudden cardiac arrest
• sudden cardiac death

Acknowledgments

The following cardiologists are acknowledged for their contribution to data collection: Paul Erne, Luzern; Jesus E. Val-Mejias, Wichita; Joerg O. Schwab, Bonn; Rainer Schimpf, Mannheim; Michael Orlov, Boston; Tom Mattioni, Phoenix; Katerina Hnatkova, St. Paul, London.

The centers involved in the study were Oslo University Hospital, Rikshospitalet, Oslo, Norway; Kantonsspital Luzern, Luzern, Switzerland; Galichia Heart Hospital, Wichita, Kansas, USA; Department of Medicine—Cardiology, University of Bonn, Bonn, Germany; University of Mannheim, Mannheim, Germany; Caritas St. Elizabeth's Hospital, Boston, Massachusetts, USA; Arizona Arrhytmia Consultants, Phoenix, Arizona, USA; St. Paul's Cardiac Electrophysiology, London, England; St. George's University of London, London, England; Mayo Clinic, Rochester, Minnesota, USA.

Declaration of interest: The authors report no declarations of interest. The authors alone are responsible for the content and writing of the paper.