Nonsustained ventricular tachycardia in older adults: real-world insights from large-scale ambulatory rhythm monitoring
P Mcgregor, R K Kerzner, D G Douglas Callahan, J G Gong, J W WesslerAbstract
Background
Ambulatory rhythm monitoring has expanded the ability to detect ventricular arrhythmias at scale. Nonsustained ventricular tachycardia (NSVT) found in individuals without documented structural heart disease is common; however, data describing its burden and demographic variation in large, real-world populations remain limited.
Purpose
To assess the prevalence of NSVT detected through ambulatory rhythm monitoring among Medicare beneficiaries and to examine variation by sex, age, and pre-existing comorbidities.
Methods
We conducted a retrospective observational analysis in 41,154 Medicare beneficiaries who had an ambulatory cardiac patch monitor between April 2025 to February 2026. Participants aged 65-75 were included if they had a prior diagnosis of unspecified arrhythmia. Participants aged 75 and above were included if they had one or more cardiovascular risk factors and symptoms concerning for arrhythmia (Figure). Those with wear time of less than 48 hours were excluded. NSVT was defined as ≥3 consecutive ventricular beats at a rate ≥100 beats/min lasting <30 seconds. Logistic regression model was fit to assess association between clinical predictors and findings of NSVT.
Results
NSVT was present in 35% (n = 14,336) of our cohort (average age of 78.19 [IQR 71.7, 84.7] years old, 38.56% male) with prevalence increasing with age. Severe ventricular arrhythmias (defined as rapid NSVT, sustained/polymorphic VT, torsades and ventricular fibrillation) were 0.08%. When compared to those without NSVT, the NSVT group was older (OR 1.01, 95% CI: 1.01-1.03), more males (OR 2.04, 95% CI: 1.95-2.13) and had longer wear time (mean 12.25 days, OR 1.11, 95% CI: 1.11-1.12). The most prevalent cardiovascular risk factors (Table) included hypertension (94.5%), symptoms (81.2%), obesity (60.3%), arrhythmia (58.4%), diabetes (52.2%), coronary artery disease (51.6%), chronic obstructive pulmonary disease (25.4%), heart failure (25.1%), and strokes (17.6%).
Conclusion
In a large, digitally monitored Medicare population, NSVT was identified in 35% of participants with prevalence associated with male gender and advancing age while malignant ventricular arrhythmias were rare. These findings demonstrate the real-world experience of ventricular arrhythmic burden at scale and may inform future approaches to risk stratification in older populations.NSVT tableNSVT flow chart