Arrhythmias & electrophysiologyCohort study
Competing risks of monomorphic vs. non-monomorphic ventricular arrhythmias in primary prevention implantable cardioverter–defibrillator recipients: Global Electrical Heterogeneity and Clinical Outcomes (GEHCO) study
- Retrospective cohort study
- multicentre
Cox models adjusted for demographics, HF severity and treatment, device programming and ECG metrics; lasso and elastic net Cox and Fine-Gray competing risk models compared out of sample
Authors' conclusion
We developed and validated models to predict the competing risks of MMVT or PVT/VF that could inform procedural planning and future randomized controlled trials of prophylactic ventricular tachycardia ablation.
Study context
- Population
- Primary prevention implantable cardioverter-defibrillator (ICD) recipients (age 63.1 ± 13.0 years; 23% female; 43% non-ischaemic cardiomyopathy; LVEF 28.2 ± 11.1%)
- Participants
- 2,668 recipients
- Exposure
- Competing risks of MMVT vs polymorphic ventricular tachycardia (PVT)/ventricular fibrillation (VF); prediction models
- Outcome
- First sustained MMVT with appropriate ICD therapy and first PVT/VF with appropriate ICD shock (competing risks)
- Follow-up
- Median 4 years
Main finding
As reported in the abstract
Risk factors and prediction of MMVT and PVT/VF
- First sustained MMVT with appropriate ICD therapy
- 359 patients
- First PVT/VF with appropriate ICD shock
- 129 patients
- MMVT risk: wider QRS-T angle (QRSTa), HR
- 1.16 (1.01-1.34) (95% CI)
- MMVT risk: larger spatial ventricular gradient elevation (SVGel), HR
- 1.17 (1.05-1.30) (95% CI)
- MMVT risk: smaller SVGmag, HR
- 0.74 (0.63-0.86) (95% CI)
- MMVT risk: smaller SAIQRST, HR
- 0.84 (0.71-0.99) (95% CI)
- Best 3-year Fine-Gray model for MMVT, ROC(t)AUC
- 0.728 (0.668-0.788) (95% CI)
- MMVT model, high-risk (> 50%): sensitivity
- 75%
- MMVT model, high-risk (> 50%): specificity
- 65%
- PVT/VF prediction model, ROC(t)AUC
- 0.915 (0.868-0.962) (95% CI)
Observational data: associations, not effects.
Original publication
Competing risks of monomorphic vs. non-monomorphic ventricular arrhythmias in primary prevention implantable cardioverter–defibrillator recipients: Global Electrical Heterogeneity and Clinical Outcomes (GEHCO) study. Europace. Published 4 May 2024. doi:10.1093/europace/euae127
Summarised from the published abstract; every number is checked against it