Ventricular tachycardia risk prediction with an abbreviated duration mobile cardiac telemetry

Abstract

Background: Ventricular tachycardia (VT) occurs intermittently, unpredictably, and has potentially lethal consequences.

Objective: Our aim was to derive a risk prediction model for VT episodes ≥10 beats detected on 30-day mobile cardiac telemetry based on the first 24 hours of the recording.

Methods: We included patients who were monitored for 2 to 30 days in the United States using full-disclosure mobile cardiac telemetry, without any VT episode ≥10 beats on the first full recording day. An elastic net prediction model was derived for the outcome of VT ≥10 beats on monitoring days 2 to 30. Potential predictors included age, sex, and electrocardiographic data from the first 24 hours: heart rate; premature atrial and ventricular complexes occurring as singlets, couplets, triplets, and runs; and the fastest rate for each event. The population was randomly split into training (70%) and testing (30%) samples.

Results: In a population of 19,781 patients (mean age 65.3 ± 17.1 years, 43.5% men), with a median recording time of 18.6 ± 9.6 days, 1510 patients had at least 1 VT ≥10 beats. The prediction model had good discrimination in the testing sample (area under the receiver-operating characteristic curve 0.7584, 95% confidence interval 0.7340-0.7829). A model excluding age and sex had an equally good discrimination (area under the receiver-operating characteristic curve 0.7579, 95% confidence interval 0.7332-0.7825). In the top quintile of the score, more than 1 in 5 patients had a VT ≥10 beats, while the bottom quintile had a 98.2% negative predictive value.

Conclusion: Our model can predict risk of VT ≥10 beats in the near term using variables derived from 24-hour electrocardiography, and could be used to triage patients to extended monitoring.

Keywords: Ambulatory ECG; Cardiac arrythmia; Epidemiology; Mobile cardiac telemetry; Prediction; Ventricular tachycardia.

Graphical abstract

Figure 1

Receiver-operating characteristic (ROC) curves for ventricular tachycardia ≥10 beats occurrence by predicted risk in the testing sample. A: Main model; B: electrocardiography-only model; C: age and sex model; D: premature ventricular complex model.