Matteo Ziacchi, Luca Ottaviano, Luca Checchi, Stefano Viani, Gerardo Nigro, Valter Bianchi, Silvana De Bonis, Paolo De Filippo, Pietro Francia, Antonio Rapacciuolo, Gennaro Vitulano, Giovanni Battista Perego, Vincenzo Schillaci, Carlo Lavalle, Federico Migliore, Ennio C L Pisanò, Paolo Compagnucci, Pietro Palmisano, Gianluca Botto, Roberto Rordorf, Mariolina Lovecchio, Sergio Valsecchi, Mauro Biffi
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引用次数: 0
Abstract
Aims: The subcutaneous implantable cardioverter defibrillator (S-ICD) is an alternative to traditional ICDs. The PRAETORIAN score, based on chest radiographs, has been validated to predict the probability of successful S-ICD defibrillation testing by assessing factors like fat thickness between the coil and sternum and generator placement. This study evaluated the correlation between the PRAETORIAN score and clinical characteristics, as well as implantation variables.
Methods and results: We retrospectively analysed data from 1253 patients who had undergone implantation of an S-ICD across 33 centres. The intermuscular positioning of the pulse generator was adopted in all patients. Post-implantation posterior-anterior and lateral chest radiographs were analysed to calculate the PRAETORIAN score. A total of 95.7% of patients had a PRAETORIAN score < 90, indicative of a low risk of conversion failure. Body mass index (BMI) was the only independent predictor of a score ≥ 90, and all patients with BMI < 25 kg/m2 (normal weight or underweight) had a score < 90. The intermuscular positioning technique resulted in optimal posterior placement of the device in all patients and significant sub-generator fat in only 3% of cases. A shock impedance value > 88 Ohm enabled to detect a PRAETORIAN score ≥ 90 with 98% (95% CI 97-99%) negative predictive value.
Conclusion: In contemporary practice, the PRAETORIAN score can be simplified. By adopting an intermuscular approach, two of the three steps of the score-evaluating the adequate posterior positioning of the generator and measuring the sub-generator fat-become superfluous, and impedance may serve as a reliable surrogate of sub-coil fat thickness. Furthermore, our data suggest that for non-obese patients, a favourable PRAETORIAN score is assured, making the score evaluation potentially unnecessary.
背景：皮下植入式心律转复除颤器（S-ICD）是传统icd的替代方案。PRAETORIAN评分基于胸片，通过评估线圈与胸骨之间的脂肪厚度和发生器放置等因素，已被证实可以预测S-ICD除颤试验成功的概率。目的：本研究评估PRAETORIAN评分与临床特征及植入变量的相关性。方法：我们回顾性分析了来自33个中心的1253例S-ICD植入患者的数据。所有患者均采用肌间定位脉冲发生器。分析植入后胸片的前后位和侧位，计算PRAETORIAN评分。结果：95.7%的患者PRAETORIAN评分为88 ω，能够检测到PRAETORIAN评分≥90,98% （95% CI 97%-99%）为阴性预测值。结论：在当代实践中，PRAETORIAN评分可以简化。通过采用肌间法，评分的三个步骤中的两个-评估发电机的适当后侧定位和测量副发电机脂肪-变得多余，阻抗可以作为副线圈脂肪厚度的可靠替代品。此外，我们的数据表明，对于非肥胖患者，有利的PRAETORIAN评分是肯定的，使得评分评估可能不必要。
期刊介绍：
EP - Europace - European Journal of Pacing, Arrhythmias and Cardiac Electrophysiology of the European Heart Rhythm Association of the European Society of Cardiology. The journal aims to provide an avenue of communication of top quality European and international original scientific work and reviews in the fields of Arrhythmias, Pacing and Cellular Electrophysiology. The Journal offers the reader a collection of contemporary original peer-reviewed papers, invited papers and editorial comments together with book reviews and correspondence.
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