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

• Published in: Europace (London, England) England), 2020-12, Vol.22 (12), p.1822-1829
• Main Authors: Francia, Pietro, Biffi, Mauro, Adduci, Carmen, Ottaviano, Luca, Migliore, Federico, De Bonis, Silvana, Dello Russo, Antonio, De Filippo, Paolo, Viani, Stefano, Bongiorni, Maria Grazia, Caravati, Fabrizio, Lavalle, Carlo, Landolina, Maurizio Eugenio, Pisanò, Ennio, Giorgi, Davide, Lovecchio, Mariolina, Valsecchi, Sergio, Diemberger, Igor
• Format: Article
• Language: English
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/euaa231

Abstract Aims 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 (