Arrhythmias & electrophysiology
Validation of the PRAETORIAN score in a large subcutaneous implantable cardioverter-defibrillator collective: Usefulness in clinical routine
Authors' conclusion
PRAETORIAN score proved to be a useful and valid predictive tool for successful DFT, whereas BMI only had a limited role. Patients with HCM were at increased risk for DFT failure or needed higher DFT energy.
Study context
- Population
- Subcutaneous implantable cardioverter-defibrillator (S-ICD) patients receiving intraoperative defibrillation testing (DFT)
- Participants
- 398 patients
- Exposure
- PRAETORIAN score as predictor of DFT failure
- Outcome
- DFT failure (validation of the PRAETORIAN score)
Methodological detailssingle-centre, Stepwise DFT protocol: 65-J standard polarity, change of polarity, increase to 80 J, repositioning if necessary; transvenous ICD if all DFTs failed
- Single-centre
- Stepwise DFT protocol: 65-J standard polarity, change of polarity, increase to 80 J, repositioning if necessary; transvenous ICD if all DFTs failed
Main finding
As reported in the abstract
DFT failure
- PRAETORIAN score independent predictor of DFT failure, OR
- 1.007, P ≤.001 (95% CI 1.003-1.011)
- BMI alone not predictive
- P = .31
Observational data: associations, not effects.
Further findings
Successful DFT with first shock
- Successful with first ICD shock
- 264 (66.3%)
- Defibrillated with second DFT
- 104
- Defibrillated with third DFT
- 10
- Needed at least 3 DFT
- 20
- DFT failures before 2015 (first-generation S-ICD)
- 88 [65.7%]
Hypertrophic cardiomyopathy (HCM) as predictor of ≥1 unsuccessful DFT
- HCM, OR
- 2.6, P = .004 (95% CI 1.3-4.4)
- Multivariate regression analysis
Original publication
Validation of the PRAETORIAN score in a large subcutaneous implantable cardioverter-defibrillator collective: Usefulness in clinical routine. Heart Rhythm. Published 19 February 2024. doi:10.
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