Implantation technique and optimal subcutaneous defibrillator chest position: a PRAETORIAN score-based study. Issue 12 (29th October 2020)

• Record Type: Journal Article
• Authors: Francia, Pietro; Biffi, Mauro; Adduci, Carmen; Ottaviano, Luca; Migliore, Federico; De Bonis, Silvana; Dello Russo, Antonio; De Filippo, Paolo; Viani, Stefano; Bongiorni, Maria Grazia; Caravati, Fabrizio; Lavalle, Carlo; Landolina, Maurizio Eugenio; Pisanò, Ennio; Giorgi, Davide; Lovecchio, Mariolina; Valsecchi, Sergio; Diemberger, Igor
• Is Part Of: Europace. Volume 22:Issue 12(2020)
• Page Start: 1822
• Page End: 1829
• Publication Date: 2020-10-29
• Subjects: Sudden death -- Implantable cardioverter defibrillator -- Subcutaneous -- Defibrillation test -- Safety -- Conversion -- PRAETORIAN score; Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/euaa231
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Aims: The traditional technique for subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation involves three incisions and a subcutaneous pocket. Recently, a two-incision and intermuscular (IM) technique has been adopted. The PRAETORIAN score is a chest radiograph-based tool that predicts S-ICD conversion testing. We assessed whether the S-ICD implantation technique affects optimal position of the defibrillation system according to the PRAETORIAN score. Methods and results: We analysed consecutive patients undergoing S-ICD implantation. The χ 2 test and regression analysis were used to determine the association between the PRAETORIAN score and implantation technique. Two hundred and thirteen patients were enrolled. The S-ICD generator was positioned in an IM pocket in 174 patients (81.7%) and the two-incision approach was adopted in 199 (93.4%). According to the PRAETORIAN score, the risk of conversion failure was classified as low in 198 patients (93.0%), intermediate in 13 (6.1%), and high in 2 (0.9%). Patients undergoing the two-incision and IM technique were more likely to have a low (<90) PRAETORIAN score than those undergoing the three-incision and subcutaneous technique (two-incision: 94.0% vs. three-incision: 78.6%; P = 0.004 and IM: 96.0% vs. subcutaneous: 79.5%; P = 0.001). Intermuscular plus two-incision technique was associated with a low-risk PRAETORIAN score (hazard ratio 3.76; 95% confidence interval 1.01–14.02; P = 0.04). Shock impedance was lower in PRAETORIAN low-risk patients than in intermediate-/high-risk categories (66 vs. 96 Ohm; P = 0.001). The PRAETORIAN score did not predict shock failure at 65 J. Conclusion: In this cohort of S-ICD recipients, combining the two-incision technique and IM generator implantation yielded the lowest PRAETORIAN score values, indicating optimal defibrillation system position. Clinical trial registration: http://clinicaltrials.gov/ Identifier: NCT02275637.