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

Autor:	Francia P; Division of Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, St. Andrea Hospital, Via di Grottarossa, 1035, 00189 Rome, Italy., Biffi M; Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy., Adduci C; Division of Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, St. Andrea Hospital, Via di Grottarossa, 1035, 00189 Rome, Italy., Ottaviano L; Istituto Clinico Sant'Ambrogio, Milan, Italy., Migliore F; Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy., De Bonis S; Division of Cardiology, Castrovillari Hospital, Cosenza, Italy., Dello Russo A; Università Politecnica delle Marche, Ancona, Italy., De Filippo P; Papa Giovanni XXIII Hospital, Bergamo, Italy., Viani S; Second Cardiology Division, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy., Bongiorni MG; Second Cardiology Division, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy., Caravati F; Division of Cardiology, 'Circolo e Fondazione Macchi' Hospital, Varese, Italy., Lavalle C; Policlinico Umberto I-'Sapienza' University of Rome, Rome, Italy., Landolina ME; Division of Cardiology, 'Maggiore' Hospital of Crema, Cremona, Italy., Pisanò E; 'Vito Fazzi' Hospital-Lecce, Lecce, Italy., Giorgi D; Division of Cardiology, 'San Luca' Hospital, Lucca, Italy., Lovecchio M; Boston Scientific, Milan, Italy., Valsecchi S; Boston Scientific, Milan, Italy., Diemberger I; Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy.
Jazyk:	angličtina
Zdroj:	Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology [Europace] 2020 Dec 23; Vol. 22 (12), pp. 1822-1829.
DOI:	10.1093/europace/euaa231
Abstrakt:	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 (<90) PRAETORIAN score than those undergoing the three-incision and subcutaneous technique (two-incision: 94.0% vs. three-incision: 78.6%; P = 0.004 and IM: 96.0% vs. subcutaneous: 79.5%; P = 0.001). Intermuscular plus two-incision technique was associated with a low-risk PRAETORIAN score (hazard ratio 3.76; 95% confidence interval 1.01-14.02; P = 0.04). Shock impedance was lower in PRAETORIAN low-risk patients than in intermediate-/high-risk categories (66 vs. 96 Ohm; P = 0.001). The PRAETORIAN score did not predict shock failure at 65 J. Conclusion: In this cohort of S-ICD recipients, combining the two-incision technique and IM generator implantation yielded the lowest PRAETORIAN score values, indicating optimal defibrillation system position. Clinical Trial Registration: http://clinicaltrials.gov/ Identifier: NCT02275637. (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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