Open Access

Implantation technique and optimal subcutaneous defibrillator chest position: a PRAETORIAN score-based study

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Date: 29 October 2020
Journal: EP Europace Journal , Volume 22 , Issue 12 , Pages 1822 - 1829
Authors: P. Francia , M. Biffi , C. Adduci , L. Ottaviano , F. Migliore , S. De Bonis , A. Dello Russo , P. De Filippo , S. Viani , M. Bongiorni , F. Caravati , C. Lavalle , M. Landolina , E. Pisanò , D. Giorgi , M. Lovecchio , S. Valsecchi , I. Diemberger

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AbstractAims

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 χ2 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.

About the contributors

Pietro Francia

Rome (Sapienza University of Rome)

Role: Author

Mauro Biffi

Role: Author

Carmen Adduci

Role: Author