PRAETORIAN-DFT Trial Validates Omission of Defibrillation Testing in S-ICD Implantation

Background

Subcutaneous implantable cardioverter-defibrillators (S-ICDs) have emerged as a vital tool in preventing sudden cardiac death (SCD) in high-risk patients. Unlike traditional transvenous ICDs, S-ICDs avoid intravascular lead complications but require precise subcutaneous positioning to ensure effective defibrillation. Historically, defibrillation (DF) testing has been recommended post-implantation to verify shock efficacy. However, DF testing carries risks, including hemodynamic instability and, in rare cases, death. The PRAETORIAN score, derived from chest X-ray analysis, was developed to predict DF success without the need for invasive testing. The PRAETORIAN-DFT trial aimed to validate this approach.

Study Design