Characterization of the PRAETORIAN score in Japanese patients undergoing subcutaneous implantable cardioverter-defibrillator implantation. Issue 5 (November 2022)

• Record Type: Journal Article
• Authors: Yamazaki, Ken; Ishida, Yuji; Sasaki, Shingo; Toyama, Yuichi; Nishizaki, Kimitaka; Kinjo, Takahiko; Itoh, Taihei; Kimura, Masaomi; Sakai, Shuntaro; Shikanai, Shun; Sorimachi, Yuya; Hamaura, Shogo; Tomita, Hirofumi
• Is Part Of: Journal of cardiology. Volume 80:Issue 5(2022)
• Page Start: 482
• Page End: 486
• Publication Date: 2022-11
• Subjects: Subcutaneous implantable cardioverter-defibrillator -- Body mass index -- PRAETORIAN score -- Optimal implantation -- Japanese; Cardiology -- Periodicals; 616.12
• DOI: 10.1016/j.jjcc.2022.06.014
• Languages: English
• ISSNs: 0914-5087

Abstract

Abstract: Background: The PRAETORIAN score was developed to evaluate the implant position and predict defibrillation success in patients implanted with a subcutaneous implantable cardioverter-defibrillator (S-ICD). However, usefulness of the PRAETORIAN score for Japanese patients is unknown. Methods: We evaluated usefulness of this score, which was determined by width of sub-coil fat, sub-generator fat, and anterior positioning of the S-ICD generator by post-operative chest X-ray, in consecutive 100 Japanese S-ICD implanted patients [78 men, median age 59 (IQR 46.5–67.0) years, median body mass index (BMI) 24.2 (21.3–27.2) kg/m 2 ]. Results: The median PRAETORIAN score was 30 (30–45) and 93 patients were classified as a low risk of conversion failure. The remaining seven were at an intermediate risk. Almost all patients were classified as an optimal pulse-generator position in the second and third steps of the PRAETORIAN score. The only difference observed was in the width of sub-coil fat in the first step. To further evaluate its significance, patients were divided into the Thicker group (sub-coil fat >1 coil width, n = 19) and the Thinner group (sub-coil fat ≤1 coil width, n = 81). BMI and post-shock impedance were both higher in the Thicker group than in the Thinner group [27.1 (25.6–31.6) versus 23.1 (20.9–25.7) kg/m 2, p < 0.001, and 75 (68–88) versus 63 (55–74) Ω, p = 0.003, respectively]. During the median follow-up periods of 888 (523–1418) days, 7 patients experienced appropriate shock therapy for spontaneous ventricular tachyarrhythmias, who were all at a low risk. No conversion failure was observed. Inappropriate shock (IAS) occurred in 11 patients, and there was no difference in IAS rate between the Thicker group ( n = 2) and the Thinner group ( n = 9) ( p = 0.747 by log-rank test). Conclusions: Most Japanese patients were classified as at low risk of conversion failure. The PRAETORIAN score may be useful for the evaluation of conversion failure in Japanese S-ICD implanted patients. Graphical abstract: Unlabelled Image Highlights: Usefulness of the PRAETORIAN score in Japanese subcutaneous implantable cardioverter-defibrillator implanted patients was studied. Sub-coil fat depth, which is affected by body mass index, is a risk of conversion failure. Most Japanese patients are at low risk of conversion failure in the PRAETORIAN score. The sub-coil fat depth is a risk determinant for conversion failure.