Competing risks of monomorphic vs. non-monomorphic ventricular arrhythmias in primary prevention implantable cardioverter–defibrillator recipients: Global Electrical Heterogeneity and Clinical Outcomes (GEHCO) study

• DOI: 10.1093/europace/euae127
• Publication Date: 2024-05-04T16:46:18Z
• Authors: Larisa G Tereshch...; Jonathan W Waks; Christine Tompkins; Albert J Rogers; Ashkan Ehdaie; Charles A Henrikson; Khidir Dalouk; Merritt Raitt; Shivangi Kewalramani; Michael W Kattan; Pasquale Santangeli; Bruce W Wilkoff; Samir R Kapadia; Sanjiv M Narayan; Sumeet S Chugh
• Keywords: Male; Time Factors; Electric Countershock; Middle Aged; Risk Assessment; Defibrillators, Implantable; Primary Prevention; Electrocardiography; Treatment Outcome; Death, Sudden, Cardiac; 0302 clinical medicine; Clinical Research; Risk Factors; Ventricular Fibrillation; Tachycardia, Ventricular; Catheter Ablation; Humans; Female; Retrospective Studies; Aged

Abstract Aims Ablation of monomorphic ventricular tachycardia (MMVT) has been shown to reduce shock frequency and improve survival. We aimed compare cause-specific risk factors for MMVT polymorphic (PVT)/ventricular fibrillation (VF) develop predictive models. Methods results The multicentre retrospective cohort study included 2668 patients (age 63.1 ± 13.0 years; 23% female; 78% white; 43% non-ischaemic cardiomyopathy; left ejection fraction 28.2 11.1%). Cox models were adjusted demographic characteristics, heart failure severity treatment, device programming, electrocardiogram metrics. Global electrical heterogeneity was measured by spatial QRS-T angle (QRSTa), gradient elevation (SVGel), azimuth, magnitude (SVGmag), sum absolute QRST integral (SAIQRST). compared the out-of-sample performance lasso elastic net proportional hazards Fine–Gray competing model. During a median follow-up 4 years, 359 experienced their first sustained with appropriate implantable cardioverter–defibrillator (ICD) therapy, 129 had PVT/VF ICD shock. associated wider QRSTa [hazard ratio (HR) 1.16; 95% confidence interval (CI) 1.01–1.34], larger SVGel (HR 1.17; CI 1.05–1.30), smaller SVGmag 0.74; 0.63–0.86) SAIQRST 0.84; 0.71–0.99). best-performing 3-year model [time-dependent area under receiver operating characteristic curve (ROC(t)AUC) 0.728; 0.668–0.788] identified high-risk (> 50%) 75% sensitivity 65% specificity, prediction ROC(t)AUC 0.915 (95% 0.868–0.962), both satisfactory calibration. Conclusion developed validated predict risks or that could inform procedural planning future randomized controlled trials prophylactic ablation. Clinical Trial Registration URL:www.clinicaltrials.gov Unique identifier:NCT03210883.