{"doi":"10.1093/europace/euae127","title":"Competing risks of monomorphic vs. non-monomorphic ventricular arrhythmias in primary prevention implantable cardioverter–defibrillator recipients: Global Electrical Heterogeneity and Clinical Outcomes (GEHCO) study","abstract":"AIMS: Ablation of monomorphic ventricular tachycardia (MMVT) has been shown to reduce shock frequency and improve survival. We aimed to compare cause-specific risk factors for MMVT and polymorphic ventricular tachycardia (PVT)/ventricular fibrillation (VF) and to develop predictive models. METHODS AND RESULTS: The multicentre retrospective cohort study included 2668 patients (age 63.1 ± 13.0 years; 23% female; 78% white; 43% non-ischaemic cardiomyopathy; left ventricular ejection fraction 28.2 ± 11.1%). Cox models were adjusted for demographic characteristics, heart failure severity and treatment, device programming, and electrocardiogram metrics. Global electrical heterogeneity was measured by spatial QRS-T angle (QRSTa), spatial ventricular gradient elevation (SVGel), azimuth, magnitude (SVGmag), and sum absolute QRST integral (SAIQRST). We compared the out-of-sample performance of the lasso and elastic net for Cox proportional hazards and the Fine-Gray competing risk model. During a median follow-up of 4 years, 359 patients experienced their first sustained MMVT with appropriate implantable cardioverter-defibrillator (ICD) therapy, and 129 patients had their first PVT/VF with appropriate ICD shock. The risk of MMVT was associated with wider QRSTa [hazard ratio (HR) 1.16; 95% confidence interval (CI) 1.01-1.34], larger SVGel (HR 1.17; 95% CI 1.05-1.30), and smaller SVGmag (HR 0.74; 95% CI 0.63-0.86) and SAIQRST (HR 0.84; 95% CI 0.71-0.99). The best-performing 3-year competing risk Fine-Gray model for MMVT [time-dependent area under the receiver operating characteristic curve (ROC(t)AUC) 0.728; 95% CI 0.668-0.788] identified high-risk (> 50%) patients with 75% sensitivity and 65% specificity, and PVT/VF prediction model had ROC(t)AUC 0.915 (95% CI 0.868-0.962), both satisfactory calibration. 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. 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Waks","orcid":"0000-0001-5560-5638","position":1,"is_corresponding":false},{"id":350880,"name":"Christine Tompkins","orcid":"0000-0003-1153-6663","position":2,"is_corresponding":false},{"id":241956,"name":"Albert J. Rogers","orcid":"0000-0001-6585-534X","position":3,"is_corresponding":false},{"id":354514,"name":"Ashkan Ehdaie","orcid":"0000-0003-0097-0026","position":4,"is_corresponding":false},{"id":954917,"name":"Charles A. Henrikson","orcid":"0000-0002-3381-8437","position":5,"is_corresponding":false},{"id":746764,"name":"Khidir Dalouk","orcid":null,"position":6,"is_corresponding":false},{"id":426742,"name":"Merritt H. Raitt","orcid":"0000-0001-5638-7732","position":7,"is_corresponding":false},{"id":1070866,"name":"Shivangi Kewalramani","orcid":"0000-0003-3272-0363","position":8,"is_corresponding":false},{"id":45522,"name":"Michael W. Kattan","orcid":"0000-0002-3840-4161","position":9,"is_corresponding":false},{"id":108267,"name":"Pasquale Santangeli","orcid":"0000-0002-0023-9666","position":10,"is_corresponding":false},{"id":1276883,"name":"Bruce W Wilkoff","orcid":null,"position":11,"is_corresponding":false},{"id":277930,"name":"Samir Kapadia","orcid":"0000-0002-0026-3391","position":12,"is_corresponding":false},{"id":241959,"name":"Sanjiv M. Narayan","orcid":"0000-0001-7552-5053","position":13,"is_corresponding":false},{"id":23013,"name":"Sumeet S. Chugh","orcid":"0000-0002-4417-5326","position":14,"is_corresponding":false},{"id":407320,"name":"Larisa G. Tereshchenko","orcid":"0000-0002-6976-1313","position":0,"is_corresponding":true}],"reference_count":41,"raw_metadata":null,"created_at":"2026-07-19T02:03:03.428151Z","pmid":"38703375","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}