{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T16:33:10Z","timestamp":1791822790306,"version":"4.3.4"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,1,21]],"date-time":"2025-01-21T00:00:00Z","timestamp":1737417600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,2,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>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\u2013anterior and lateral chest radiographs were analysed to calculate the PRAETORIAN score. A total of 95.7% of patients had a PRAETORIAN score &amp;lt; 90, indicative of a low risk of conversion failure. Body mass index (BMI) was the only independent predictor of a score \u2265 90, and all patients with BMI &amp;lt; 25\u2005kg\/m2 (normal weight or underweight) had a score &amp;lt; 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 &amp;gt; 88\u2005Ohm enabled to detect a PRAETORIAN score \u2265 90 with 98% (95% CI 97\u201399%) negative predictive value.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>In contemporary practice, the PRAETORIAN score can be simplified. By adopting an intermuscular approach, two of the three steps of the score\u2014evaluating the adequate posterior positioning of the generator and measuring the sub-generator fat\u2014become 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical trial registration<\/jats:title>\n                  <jats:p>URL: http:\/\/clinicaltrials.gov\/ Identifier: NCT02275637.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/europace\/euaf011","type":"journal-article","created":{"date-parts":[[2025,1,21]],"date-time":"2025-01-21T08:13:59Z","timestamp":1737447239000},"source":"Crossref","is-referenced-by-count":8,"title":["The risk of failure of subcutaneous implantable cardioverter defibrillator therapy: from PRAETORIAN score to clinical practice"],"prefix":"10.1093","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3617-2739","authenticated-orcid":false,"given":"Matteo","family":"Ziacchi","sequence":"first","affiliation":[{"name":"Institute of Cardiology, IRCCS Azienda Ospedaliero Universitaria di Bologna , Via Massarenti n. 9, Bologna 40138 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1496-8963","authenticated-orcid":false,"given":"Luca","family":"Ottaviano","sequence":"additional","affiliation":[{"name":"Arrhythmia and Electrophysiology Unit, Cardiothoracic Department IRCCS Galeazzi\u2014S. Ambrogio , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9510-9495","authenticated-orcid":false,"given":"Luca","family":"Checchi","sequence":"additional","affiliation":[{"name":"Electrophysiology Unit, Careggi University Hospital , Florence ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8240-9181","authenticated-orcid":false,"given":"Stefano","family":"Viani","sequence":"additional","affiliation":[{"name":"Second Cardiology Division, Cardio-Thoracic and Vascular Department, University Hospital of Pisa , Pisa ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1776-8449","authenticated-orcid":false,"given":"Gerardo","family":"Nigro","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Sciences, University of Campania \u2018Luigi Vanvitelli\u2019 , Naples ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2678-7836","authenticated-orcid":false,"given":"Valter","family":"Bianchi","sequence":"additional","affiliation":[{"name":"\u2018U.O.C. di Cardiologia-UTIC\u2019 Department\u2014Azienda Ospedaliera \u2018dei Colli\u2019\u2014Ospedale Monaldi , Naples ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvana","family":"De Bonis","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Castrovillari Hospital , Cosenza ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1144-5000","authenticated-orcid":false,"given":"Paolo","family":"De Filippo","sequence":"additional","affiliation":[{"name":"Cardiac Electrophysiology and Pacing Unit, Papa Giovanni XXIII Hospital , Bergamo ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0306-7764","authenticated-orcid":false,"given":"Pietro","family":"Francia","sequence":"additional","affiliation":[{"name":"Cardiology, Department of Clinical and Molecular Medicine, Sant\u2019Andrea Hospital, University Sapienza , Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4739-7004","authenticated-orcid":false,"given":"Antonio","family":"Rapacciuolo","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Sciences, Federico II University of Naples , Naples ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gennaro","family":"Vitulano","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Ospedali Riuniti San Giovanni di Dio e Ruggi D\u2019Aragona , Salerno ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8735-7851","authenticated-orcid":false,"given":"Giovanni Battista","family":"Perego","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Istituto Auxologico Italiano , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3016-2583","authenticated-orcid":false,"given":"Vincenzo","family":"Schillaci","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Casa Di Cura Montevergine , Mercogliano ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0794-4296","authenticated-orcid":false,"given":"Carlo","family":"Lavalle","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari Universit\u00e0 Sapenza Roma , Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8574-9421","authenticated-orcid":false,"given":"Federico","family":"Migliore","sequence":"additional","affiliation":[{"name":"Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova , Padua ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0187-0492","authenticated-orcid":false,"given":"Ennio C L","family":"Pisan\u00f2","sequence":"additional","affiliation":[{"name":"Cardiology and Intensive Care Unit, Ospedale \u2018V. Fazzi\u2019, Lecce ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1924-6548","authenticated-orcid":false,"given":"Paolo","family":"Compagnucci","sequence":"additional","affiliation":[{"name":"Cardiology and Arrhythmology Clinic, Universit\u00e0 Politecnica delle Marche , Ancona ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6705-6218","authenticated-orcid":false,"given":"Pietro","family":"Palmisano","sequence":"additional","affiliation":[{"name":"Cardiology Unit, \u2018Card. G. Panico\u2019 Hospital , Tricase ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8049-7517","authenticated-orcid":false,"given":"Gianluca","family":"Botto","sequence":"additional","affiliation":[{"name":"U.O. Electrophysiology, ASST Rhodense , Rho-Garbagnate Milanese (MI) ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4111-1690","authenticated-orcid":false,"given":"Roberto","family":"Rordorf","sequence":"additional","affiliation":[{"name":"Arrhythmias and Electrophysiology Unit, Division of Cardiology, IRCCS Policlinico S. Matteo , Pavia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariolina","family":"Lovecchio","sequence":"additional","affiliation":[{"name":"Cardiac Rhythm Management, Boston Scientific , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7055-6942","authenticated-orcid":false,"given":"Sergio","family":"Valsecchi","sequence":"additional","affiliation":[{"name":"Cardiac Rhythm Management, Boston Scientific , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4590-8584","authenticated-orcid":false,"given":"Mauro","family":"Biffi","sequence":"additional","affiliation":[{"name":"Institute of Cardiology, IRCCS Azienda Ospedaliero Universitaria di Bologna , Via Massarenti n. 9, Bologna 40138 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,1,21]]},"reference":[{"key":"2025030423515841700_euaf011-B1","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1056\/NEJMoa1915932","article-title":"Subcutaneous or transvenous defibrillator therapy","volume":"383","author":"Knops","year":"2020","journal-title":"N Engl J Med"},{"key":"2025030423515841700_euaf011-B2","doi-asserted-by":"crossref","first-page":"4872","DOI":"10.1093\/eurheartj\/ehac496","article-title":"Device-related complications in subcutaneous versus transvenous ICD: a secondary analysis of the PRAETORIAN trial","volume":"43","author":"Knops","year":"2022","journal-title":"Eur Heart J"},{"key":"2025030423515841700_euaf011-B3","doi-asserted-by":"crossref","first-page":"1658","DOI":"10.7326\/M22-1566","article-title":"Perioperative safety and early patient and device outcomes among subcutaneous versus transvenous implantable cardioverter defibrillator implantations: a randomized, multicenter trial","volume":"175","author":"Healey","year":"2022","journal-title":"Ann Intern Med"},{"key":"2025030423515841700_euaf011-B4","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/j.jacep.2016.10.016","article-title":"Determinants of subcutaneous implantable cardioverter-defibrillator efficacy: a computer modeling study","volume":"3","author":"Heist","year":"2017","journal-title":"JACC Clin Electrophysiol"},{"key":"2025030423515841700_euaf011-B5","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/j.hrthm.2018.09.029","article-title":"A novel tool to evaluate the implant position and predict defibrillation success of the subcutaneous implantable cardioverter-defibrillator: the PRAETORIAN score","volume":"16","author":"Quast","year":"2019","journal-title":"Heart Rhythm"},{"key":"2025030423515841700_euaf011-B6","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1093\/europace\/euv411","article-title":"2015 HRS\/EHRA\/APHRS\/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing","volume":"18","author":"Wilkoff","year":"2016","journal-title":"Europace"},{"key":"2025030423515841700_euaf011-B7","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.ahj.2019.05.002","article-title":"Rationale and design of the PRAETORIAN-DFT trial: a prospective randomized CompArative trial of SubcutanEous ImplanTable CardiOverter-DefibrillatoR ImplANtation with and without DeFibrillation testing","volume":"214","author":"Quast","year":"2019","journal-title":"Am Heart J"},{"key":"2025030423515841700_euaf011-B8","doi-asserted-by":"crossref","first-page":"1423","DOI":"10.1093\/europace\/euad028","article-title":"Intermuscular technique for implantation of the subcutaneous implantable defibrillator: a propensity-matched case\u2013control study","volume":"25","author":"Botto","year":"2023","journal-title":"Europace"},{"key":"2025030423515841700_euaf011-B9","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/s10840-018-0326-2","article-title":"Subcutaneous implantable cardioverter defibrillator eligibility according to a novel automated screening tool and agreement with the standard manual electrocardiographic morphology tool","volume":"52","author":"Francia","year":"2018","journal-title":"J Interv Card Electrophysiol"},{"key":"2025030423515841700_euaf011-B10","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1111\/pace.12987","article-title":"Intermuscular two-incision technique for subcutaneous implantable cardioverter defibrillator implantation: results from a multicenter registry","volume":"40","author":"Migliore","year":"2017","journal-title":"Pacing Clin Electrophysiol"},{"key":"2025030423515841700_euaf011-B11","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1161\/CIRCULATIONAHA.113.003042","article-title":"Safety and efficacy of a totally subcutaneous implantable-cardioverter defibrillator","volume":"128","author":"Weiss","year":"2013","journal-title":"Circulation"},{"key":"2025030423515841700_euaf011-B12","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1016\/j.hrthm.2024.02.005","article-title":"Predictive value of the PRAETORIAN score for defibrillation test success in patients with subcutaneous ICD: a subanalysis of the PRAETORIAN-DFT trial","volume":"21","author":"Knops","year":"2024","journal-title":"Heart Rhythm"},{"key":"2025030423515841700_euaf011-B13","doi-asserted-by":"crossref","first-page":"1822","DOI":"10.1093\/europace\/euaa231","article-title":"Implantation technique and optimal subcutaneous defibrillator chest position: a PRAETORIAN score-based study","volume":"22","author":"Francia","year":"2020","journal-title":"Europace"},{"key":"2025030423515841700_euaf011-B14","doi-asserted-by":"crossref","first-page":"e006665","DOI":"10.1161\/CIRCEP.118.006665","article-title":"Factors associated with high-voltage impedance and subcutaneous implantable defibrillator ventricular fibrillation conversion success","volume":"12","author":"Amin","year":"2019","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2025030423515841700_euaf011-B15","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1016\/j.hrthm.2023.12.018","article-title":"Correlation between high- and low-voltage impedance measurements following subcutaneous implantable cardioverter-defibrillator implantation","volume":"21","author":"Sink","year":"2024","journal-title":"Heart Rhythm"},{"key":"2025030423515841700_euaf011-B16","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/j.hrthm.2007.11.018","article-title":"Complications associated with defibrillation threshold testing: the Canadian experience","volume":"5","author":"Birnie","year":"2008","journal-title":"Heart Rhythm"},{"key":"2025030423515841700_euaf011-B17","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1016\/S0140-6736(14)61903-6","article-title":"Cardioverter defibrillator implantation without induction of ventricular fibrillation: a single-blind, non-inferiority, randomised controlled trial (SIMPLE)","volume":"385","author":"Healey","year":"2015","journal-title":"Lancet"},{"key":"2025030423515841700_euaf011-B18","doi-asserted-by":"crossref","first-page":"2500","DOI":"10.1093\/eurheartj\/ehv292","article-title":"Intra-operative defibrillation testing and clinical shock efficacy in patients with implantable cardioverter-defibrillators: the NORDIC ICD randomized clinical trial","volume":"36","author":"B\u00e4nsch","year":"2015","journal-title":"Eur Heart J"},{"key":"2025030423515841700_euaf011-B19","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1016\/j.jacc.2012.05.014","article-title":"Clinical evaluation of defibrillation testing in an unselected population of 2,120 consecutive patients undergoing first implantable cardioverter-defibrillator implant","volume":"60","author":"Brignole","year":"2012","journal-title":"J Am Coll Cardiol"},{"key":"2025030423515841700_euaf011-B20","doi-asserted-by":"crossref","first-page":"1456","DOI":"10.1016\/j.hrthm.2017.05.016","article-title":"Subcutaneous implantable cardioverter-defibrillator post-approval study: clinical characteristics and perioperative results","volume":"14","author":"Gold","year":"2017","journal-title":"Heart Rhythm"},{"key":"2025030423515841700_euaf011-B21","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1001\/jamacardio.2016.2782","article-title":"Trends and in-hospital outcomes associated with adoption of the subcutaneous implantable cardioverter defibrillator in the United States","volume":"1","author":"Friedman","year":"2016","journal-title":"JAMA Cardiol"},{"key":"2025030423515841700_euaf011-B22","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1016\/j.jacc.2017.06.040","article-title":"Implant and midterm outcomes of the subcutaneous implantable cardioverter-defibrillator registry: the EFFORTLESS study","volume":"70","author":"Boersma","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"2025030423515841700_euaf011-B23","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.ijcard.2018.07.139","article-title":"Subcutaneous implantable cardioverter defibrillator implantation: an analysis of Italian clinical practice and its evolution","volume":"272","author":"D\u2019Onofrio","year":"2018","journal-title":"Int J Cardiol"},{"key":"2025030423515841700_euaf011-B24","doi-asserted-by":"crossref","first-page":"euad239","DOI":"10.1093\/europace\/euad239","article-title":"Modern subcutaneous implantable defibrillator therapy in patients with cardiomyopathies and channelopathies: data from a large multicentre registry","volume":"25","author":"Migliore","year":"2023","journal-title":"Europace"},{"key":"2025030423515841700_euaf011-B25","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1016\/j.jacep.2020.11.001","article-title":"Is 40","volume":"7","author":"Biffi","year":"2021","journal-title":"JACC Clin Electrophysiol"},{"key":"2025030423515841700_euaf011-B26","first-page":"100952","article-title":"The \u2018Defibrillation Testing, Why Not?\u2019 survey. Testing of subcutaneous and transvenous defibrillators in the Italian clinical practice","volume":"38","author":"Migliore","year":"2022","journal-title":"Int J Cardiol Heart Vasc"},{"key":"2025030423515841700_euaf011-B27","doi-asserted-by":"crossref","first-page":"3035","DOI":"10.1111\/jce.15254","article-title":"Intraprocedural PRAETORIAN score for early assessment of S-ICD implantation: a proof-of-concept study","volume":"32","author":"Gasperetti","year":"2021","journal-title":"J Cardiovasc Electrophysiol"}],"container-title":["Europace"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/europace\/advance-article-pdf\/doi\/10.1093\/europace\/euaf011\/61524419\/euaf011.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/europace\/article-pdf\/27\/2\/euaf011\/61524419\/euaf011.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/europace\/article-pdf\/27\/2\/euaf011\/61524419\/euaf011.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T23:52:18Z","timestamp":1741132338000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/europace\/article\/doi\/10.1093\/europace\/euaf011\/7965154"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,21]]},"references-count":27,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,2,5]]}},"URL":"https:\/\/doi.org\/10.1093\/europace\/euaf011","relation":{},"ISSN":["1099-5129","1532-2092"],"issn-type":[{"value":"1099-5129","type":"print"},{"value":"1532-2092","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,2]]},"published":{"date-parts":[[2025,1,21]]},"article-number":"euaf011"}}