Arrhythmias & electrophysiology
Integration of PRAETORIAN Score, defibrillation testing and follow-up outcomes for the assessment of conversion failure in patients with subcutaneous implantable cardioverter defibrillator: Results from the iSUSI registry
Authors' conclusion
PRAETORIAN score, BMI, and impedance are independent predictors of defibrillation failure. Their combined use may improve risk stratification and may help guide clinical decision-making, especially when DFT is omitted.
Study context
- Population
- Patients with subcutaneous implantable cardioverter defibrillator (S-ICD) with available imaging and complete follow-uppatients analyzed, 748 underwent defibrillation testing (DFT)
- Participants
- 1,063 patients
- Exposure
- PRAETORIAN score and individual components; multivariable model combining PRAETORIAN score, body mass index (BMI), and impedance vs PRAETORIAN score
- Outcome
- Composite of:
- DFT failure
- Ineffective appropriate shocks during follow-up
Methodological detailsinternational, real-world
- International
- Real-world
Main finding
As reported in the abstract
Observational data: associations, not effects.
Further findings
Independent predictors of conversion failure
| Comparison | Odds ratio (CI) | P value | |
|---|---|---|---|
| Anterior generator position at PRAETORIAN score step 2 | 2.3 (1.2–4.2) | P = 0.006 | |
| 0.20.5125Odds ratio (log scale) |
| Outcome | AUC | P value |
|---|---|---|
| Model performance (AUC) | 0.78 vs 0.71 | P = 0.0078 |
- Model performance (AUC) — Overall PRAETORIAN score AUC
- 0.71
- Model performance (AUC) — step 1-3 AUCs
- 0.68-0.70
- Model performance (AUC) — Overall vs individual steps
- P > .05 for all comparisons
DFT failure and ineffective shocks
- DFT failure among 748 patients who underwent DFT
- 64 (8.6%)
- Ineffective shocks during follow-up
- 17
Independent predictors of conversion failure
- PRAETORIAN score step 1, high body mass index (BMI) and post-shock impedance independently predicted conversion failure
Original publication
Integration of PRAETORIAN Score, defibrillation testing and follow-up outcomes for the assessment of conversion failure in patients with subcutaneous implantable cardioverter defibrillator: Results from the iSUSI registry. Heart Rhythm. Published 26 June 2026. doi:10.
Summarised from the published abstract; every number is checked against it