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Comparative Efficacy, Safety, and Complications of Subcutaneous Versus Transvenous Implantable Cardioverter-Defibrillators: Insights from the PRAETORIAN and ATLAS Trials and Meta-Analyses

MedXY Editorial Team•Dec 25, 2025•Cardiology
implantable cardioverter-defibrillatorSubcutaneous ICDTransvenous ICD

Highlights

  • Subcutaneous ICDs (S-ICDs) significantly reduce lead-related complications compared with transvenous ICDs (TV-ICDs), especially over long-term follow-up.
  • Inappropriate shocks occur more frequently with S-ICDs primarily due to cardiac oversensing and electromagnetic interference, whereas TV-ICDs have higher inappropriate shocks related to atrial arrhythmias.
  • Appropriate shock efficacy of S-ICDs is comparable to TV-ICDs, despite the lack of antitachycardia pacing in S-ICDs, although S-ICD recipients may receive more shocks.
  • Device selection should be individualized, considering pacing needs, risk of lead-related complications, and the causes of inappropriate shocks.

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This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

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PRAETORIAN-DFT Trial Validates Omission of Defibrillation Testing in S-ICD ImplantationThe PRAETORIAN-DFT trial demonstrates that omitting defibrillation testing in subcutaneous ICD implantation, guided by the PRAETORIAN score, is non-inferior to traditional testing for first-shock efficacy, reducing procedural risks without Apr 28, 2026
Long-Term Safety of Subcutaneous vs. Transvenous ICDs: Results from the PRAETORIAN-XL TrialThe PRAETORIAN-XL trial shows subcutaneous ICDs have fewer major and lead-related complications than transvenous ICDs over 8 years, suggesting S-ICD as a safer option for patients without pacing needs.Oct 3, 2025