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

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

*Corresponding author for this work
7 Citations (Scopus)

Abstract

Introduction: The PRAETORIAN score (PS) was developed to assess the implant position and predict defibrillation success of the subcutaneous implantable cardioverter defibrillators (S-ICD). The main critique moved to the routine use of PS has been its postprocedural timing, that limits its usefulness on procedure guidance. The aim of this proof-of-concept study was to assess the feasibility of an intraprocedural use of PS. Methods: Forty consecutive patients undergoing S-ICD implantation were enrolled. Intraprocedural PS (IP-PS) obtained with fluoroscopy before closure of the pocket and postprocedural PS (PP-PS) obtained with two-views chest X-ray were compared. Intraprocedural data and PS were compared with the historic cohorts of the involved institutions. Results: When assessing IP-PS and PP-PS, a complete overall agreement was observed (100%, 1.00-κ; p <.001). When assessing a per-step agreement, a very high-degree of concordance in evaluating Step 1 of the PS was observed (95%, 0.81-κ; p <.001). A complete agreement in Step 2–3 (100%, 1.00-κ; p <.001) of the PS was reported. In comparison with our historical cohort, procedural time in the IP-PS cohort did not increase (45 [41–52] vs. 45 [39–49] min; p =.351) while the expected increase in fluoroscopy time resulted scarce (15 [10–15] s). Conclusion: An IP-PS can be reliably obtained using fluoroscopy guidance during S-ICD implantation, without a significant increase in procedural duration and may serve as guidance for implanting physicians, to avoid postprocedural S-ICD repositioning, leading to patient discomfort and significantly enhancing infective risks. IP-PS showed a very high agreement with the PP-PS obtained from two-views chest X-ray.

Original languageEnglish
JournalJournal of Cardiovascular Electrophysiology
Volume32
Issue number11
Pages (from-to)3035-3041
Number of pages7
ISSN1045-3873
DOIs
Publication statusPublished - 11.2021

Research Areas and Centers

  • Centers: Cardiological Center Luebeck (UHZL)

DFG Research Classification Scheme

  • 205-12 Cardiology, Angiology

Cite this