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Background: PRAETORIAN is the first randomized controlled trial that demonstrated the noninferiority of subcutaneous ICD (S-ICD) in comparison with transvenous ICD (TV-ICD). We retrospectively reviewed electronic records of patients with ICD implanted over the past 6 years, with the primary objective to compare our real-world single tertiary center experience with the randomized data from the PRAETORIAN study.Methods: Seventy S-ICD patients were compared with 197 TV-ICD patients, from July 2014 to June 2020 retrospectively, over a median period of 1304 days (296-2451 days). Primary composite endpoints included inappropriate shocks and devicerelated malfunctions.Results: Patients with S-ICD implantation were younger than those who received TV-ICD (mean, 49.7 years vs 63.9 years, p < .001). About 31.4% of S-ICDs were implanted for secondary prevention, and 58.6% of S-ICD patients had ischemic cardiomyopathy (ICM) with a median left ventricular ejection fraction of 32.5% (range: 10-67%). S-ICDs and TV-ICD had statistically similar inappropriate shocks (4.3% vs 4.6%, p = .78), device-related complications (11.4% vs 9.1%, p = .93), and the overall primary endpoints (15.7% vs 13.7%, p = .68). The findings remained the same even after age and gender adjustments and time-dependent analysis. Conclusion:Although single-center experience with a small number of S-ICD patients, results of the PRAETORIAN study has been replicated in our real-world experience of S-ICD and TV-ICD implantations across diverse etiologies, indications, and age groups confirming the comparable performance of S-ICD and TV-ICD when implanted in selected patients.

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Atrial fibrillation (AF) is becoming increasingly common in an ageing population. Much of the morbidity and mortality in AF is due to stroke and thromboembolism. Awareness of stroke risk and the need for prevention is well recognized but is far from satisfactory in the real world. Despite refinements in the risk stratification over the years, there is an unmet need for appropriate thromboprophylaxis due to the underuse of oral anticoagulation. Primary care physicians and generalists bear the burden of managing AF. Coordinated multidisciplinary efforts by cardiologists, primary care physicians, and neurologists may be needed to meet the increasing challenge of stroke prevention and rhythm management in AF. This article discusses the potential the role of the cardiologist in the management of stroke prevention in patients with AF.

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