SCIENCE@home

Validation of the PRAETORIAN Score in a large S-ICD collective - usefulness in clinical routine.

F. Doldi,Gerrit Frommeyer,A. Löher,C. Ellermann,J. Wolfes,F. Güner,Mathis Zerbst,Hauke Engelke,Dennis Korthals,F. Reinke,L. Eckardt,K. Willy

Published 2024 in Heart Rhythm

ABSTRACT

BACKGROUND To assess the risk of unsuccessful conversion of ventricular fibrillation (VF) during defibrillation testing (DFT) with the subcutaneous implantable cardioverter defibrillator (S-ICD) the PRAETORIAN Score has been proposed. OBJECTIVE We aimed at validating this score in a large S-ICD collective METHODS: A retrospective single-center analysis of S-ICD patients receiving intraoperative DFT was performed. DFT was performed using a stepwise protocol with 65J standard polarity, change of polarity, increase to 80J, and re-positioning if necessary. In case all DFT failed, we switched to a transvenous ICD. RESULTS Overall, 398 patients were analyzed (n=268 male; 67.3%, mean age 42.4±15.9 years, mean BMI 25.9±4.8 kg/m2). Successful DFT with the first ICD shock was observed in 264 (66.3%) patients. 114 patients were defibrillated with the second (n=104) or third (n=10) DFT after changing shock polarity and/or shock energy. Overall, twenty patients needed at least 3 DFT (i.e. 80J and/or re-positioning). The majority (n=88, 65.7%) of DFT failures happened before 2015 with the first S-ICD generation. PRAETORIAN Score was an independent predictor of DFT failure (OR 1.007, CI 1.003, 1.011, p ≤0.001) while BMI alone was not (p=0.31). Presence of hypertrophic cardiomyopathy (HCM) (OR 2.6; CI 1.3, 4.4, p=0.004) was predictive for at least one unsuccessful DFT in our multivariate regression analysis. 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 in need of higher DFT energy.

PUBLICATION RECORD

CITATION MAP

EXTRACTION MAP

CLAIMS

  • No claims are published for this paper.

CONCEPTS

  • No concepts are published for this paper.

REFERENCES

Showing 1-31 of 31 references · Page 1 of 1

CITED BY

Showing 1-4 of 4 citing papers · Page 1 of 1