Intraprocedural PRAETORIAN score for early assessment of S‐ICD implantation: A proof‐of‐concept study

Gasperetti, Alessio; Schiavone, Marco; Biffi, Mauro; Casella, Michela; Compagnucci, Paolo; Mitacchione, Gianfranco; Angeletti, Andrea; Vogler, Julia; Proietti, Riccardo; Ziacchi, Matteo; Russo, Antonio Dello; Tilz, Roland Richard; Forleo, Giovanni B.

doi:10.1111/jce.15254

Cited by 11 publications

(3 citation statements)

References 13 publications

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“…The PRAETORIAN score was collected as per existing definition, either from a two-projection post-procedural chest X-ray or intra-procedurally. 17–19 Baseline device programming setup and the rate of SMART Pass algorithm use for inappropriate shock risk reduction 20 were collected as well. Follow-up strategy was left to each centre’s policy, with most patients being evaluated at 1, 6, and 12 months and every 6 months thereafter.…”

Section: Methodsmentioning

confidence: 99%

Impact of ventricular tachycardia ablation in subcutaneous implantable cardioverter defibrillator carriers: a multicentre, international analysis from the iSUSI project

Schiavone,

Gasperetti,

Compagnucci

et al. 2024

Europace

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Aims Catheter ablation (CA) of ventricular tachycardia (VT) has become an important tool to improve clinical outcomes in patients with appropriate transvenous implantable cardioverter defibrillator (ICD) shocks. The aim of our analysis was to test whether VT ablation (VTA) impacts long-term clinical outcomes even in subcutaneous ICD (S-ICD) carriers. Methods and results International Subcutaneous Implantable Cardioverter Defibrillator (iSUSI) registry patients who experienced either an ICD shock or a hospitalization for monomorphic VT were included in this analysis. Based on an eventual VTA after the index event, patients were divided into VTA+ vs. VTA− cohorts. Primary outcome of the study was the occurrence of a combination of device-related appropriate shocks, monomorphic VTs, and cardiovascular mortality. Secondary outcomes were addressed individually. Among n = 1661 iSUSI patients, n = 211 were included: n = 177 experiencing ICD shocks and n = 34 hospitalized for VT. No significant differences in baseline characteristics were observed. Both the crude and the yearly event rate of the primary outcome (5/59 and 3.8% yearly event rate VTA+ vs. 41/152 and 16.4% yearly event rate in the VTA−; log-rank: P value = 0.0013) and the cardiovascular mortality (1/59 and 0.7% yearly event rate VTA+ vs. 13/152 and 4.7% yearly event rate VTA−; log-rank P = 0.043) were significantly lower in the VTA + cohort. At multivariate analysis, VTA was the only variable remaining associated with a lower incidence of the primary outcome [adjusted hazard ratio 0.262 (0.100–0.681), P = 0.006]. Conclusion In a real-world registry of S-ICD carriers, the combined study endpoint of arrhythmic events and cardiovascular mortality was lower in the patient cohort undergoing VTA at long-term follow-up. ClinicalTrials.gov identifier NCT0473876.

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Section: Methodsmentioning

confidence: 99%

Impact of ventricular tachycardia ablation in subcutaneous implantable cardioverter defibrillator carriers: a multicentre, international analysis from the iSUSI project

Schiavone,

Gasperetti,

Compagnucci

et al. 2024

Europace

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“…A score was validated on an independent cohort of S-ICD recipients [ 94 , 95 ], and it holds true even in obese patients [ 96 ]. Intraoperative calculation of the score was proved feasible [ 97 ]. But appropriate determination of the score is to some extent subjective, and may necessitate some form of training [ 98 ].…”

Section: Defibrillation Testingmentioning

confidence: 99%

S-ICD Implantation "Tips and Tricks"

Budrejko¹,

Kempa²,

Przybylski³

2023

Rev. Cardiovasc. Med.

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An implantable cardioverter-defibrillator (ICD) was developed to provide protection against sudden cardiac death. Despite being effective in terminating ventricular arrhythmias, traditional transvenous ICDs appeared over time to have certain limitations related to the need for vascular access and the presence of foreign material inside the circulatory system (namely lead failure and infections). A subcutaneous implantable cardioverter-defibrillator (S-ICD) was developed to overcome those limitations and to provide prevention against sudden cardiac death from outside the cardiovascular system. Utilization of that modern method of treatment is constantly increasing worldwide, and new centers incorporate implantation of that system in their portfolio. This review aims to present the most relevant issues related to S-ICD implantation procedure, based on experience of the authors and an extensive literature search.

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“…Currently, the next step of research is ongoing, with the aim of skipping DFT entirely and substituting it with the score evaluation only (i.e., prospective validation of the score by randomizing to standard DFT or using only the score without conversion testing; the PRAETORIAN DFT study) [ 10 ]. Moreover, in a recent proof-of-concept study [ 17 ], the intraprocedural assessment of the score was found to be feasible.…”

Section: Introductionmentioning

confidence: 99%

Real-Life Inter-Rater Variability of the PRAETORIAN Score Values

Budrejko

Kempa

Krupa

et al. 2022

IJERPH

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(1) Background: The PRAETORIAN score is a tool developed for postoperative evaluation of the position of subcutaneous implantable cardioverter-defibrillator systems. The aim of our study was to evaluate the real-life inter-rater variability of the PRAETORIAN score, based on chest radiographs of S-ICD patients reviewed by independent clinical raters. (2) Methods: Postoperative chest X-rays of patients that underwent S-ICD implantation were evaluated by five clinical raters who gave values of the PRAETORIAN score. Ratings were then compared in a fully crossed manner to determine the inter-rater variability of the attributed scores. (3) Results: In total, 87 patients were included in the study. In the case of the most important final risk category of the PRAETORIAN score, the mean Light’s kappa was 0.804, the Fleiss’ kappa was 0.249, and the intraclass correlation was 0.38. The final risk category was identically determined by all five raters in 75.86% of patients, by four raters in 14.94%, and by three raters in 9.20% of patients. (4) Conclusions: The overall inter-rater variability of the PRAETORIAN score in a group of electrophysiologists experienced in S-ICD implantation, yet previously naive to the PRAETORIAN score, and self-trained in its utilization, was only modest in our study. Appropriate use of the score might require training of clinical raters.

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Intraprocedural PRAETORIAN score for early assessment of S‐ICD implantation: A proof‐of‐concept study

Cited by 11 publications

References 13 publications

Impact of ventricular tachycardia ablation in subcutaneous implantable cardioverter defibrillator carriers: a multicentre, international analysis from the iSUSI project

Impact of ventricular tachycardia ablation in subcutaneous implantable cardioverter defibrillator carriers: a multicentre, international analysis from the iSUSI project

S-ICD Implantation "Tips and Tricks"

Real-Life Inter-Rater Variability of the PRAETORIAN Score Values

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