{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T16:19:50Z","timestamp":1790266790309,"version":"4.1.0"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Boston Scientific Corporation","award":["ISRCAR00081"],"award-info":[{"award-number":["ISRCAR00081"]}]}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2026,8,11]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>To improve survival of patients at risk of sudden cardiac death, subcutaneous implantable cardioverter defibrillators (S-ICDs) require optimal implant positioning for effective shocks. Defibrillation (DF) testing is recommended but carries serious risks. The PRAETORIAN score predicts defibrillation outcomes on the basis of chest X-ray. The PRAETORIAN-DFT (Prospective Randomized Comparative Trial of Subcutaneous Implantable Cardioverter Defibrillator Implantation With and Without Defibrillation Testing) trial evaluated whether omission of DF testing guided by the PRAETORIAN score is noninferior for first-shock efficacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>In this multinational trial, S-ICD patients from 37 centers were randomized to DF testing or no DF testing. In the No-DF testing group, the PRAETORIAN score was evaluated before discharge. The primary end point was failed first shock for spontaneous ventricular arrhythmias, as a surrogate for defibrillation success, tested for noninferiority with a 3% absolute risk margin. Secondary end points included mortality, potential DF testing\u2013related complications, and S-ICD revisions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      The included 965 patients (No-DF testing, n=483; DF testing, n=482) were followed for a median of 41 months. Failed first shock for spontaneous ventricular arrhythmia occurred in 1.7% of the No-DF testing group versus 2.3% of the DF testing group (\u20130.6% [95% CI, \u20132.6 to 1.4],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001). There were no significant differences in all-cause mortality (hazard ratio [HR], 0.9 [95% CI, 0.6\u20131.4]) or arrhythmic death (HR, 0.4 [95% CI, 0.04\u20133.4]). Potential DF testing\u2013related complications occurred in 1.7% in the DF testing group. Postoperative S-ICD revisions due to inadequate positioning were identical between groups (n=2 each).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>PRAETORIAN score\u2013guided omission of DF testing after S-ICD implantation did not increase the risk of failed first shocks for spontaneous ventricular arrhythmias and reduced procedural risk without increasing S-ICD revisions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT03495297.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.126.080638","type":"journal-article","created":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T13:00:14Z","timestamp":1777122014000},"page":"520-531","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Subcutaneous Defibrillator Implantation With or Without Defibrillation Test: The Primary Results of the Randomized PRAETORIAN-DFT Trial"],"prefix":"10.1161","volume":"154","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0772-3573","authenticated-orcid":true,"given":"Reinoud E.","family":"Knops","sequence":"first","affiliation":[{"name":"Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart Failure &amp; Arrhythmias, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands (R.E.K., L.A.D., A.-F.B.E.Q., T.F.B., A.d.W., N.R.B., W.v.d.S., J.A.d.V., K.M.K., S.P., A.A.M.W., L.R.A.O.N., L.S., L.V.A.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8242-3551","authenticated-orcid":true,"given":"Christelle","family":"Marquie","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital of Lille, Lille, France (C.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2560-4068","authenticated-orcid":true,"given":"Peter","family":"Nordbeck","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University and University Hospital W\u00fcrzburg, W\u00fcrzburg, Germany (P.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0122-7130","authenticated-orcid":true,"given":"Roland R.","family":"Tilz","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Heart Center, L\u00fcbeck, Germany (R.R. Tilz)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1064-6118","authenticated-orcid":true,"given":"Leonard A.","family":"Dijkshoorn","sequence":"additional","affiliation":[{"name":"Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart Failure &amp; Arrhythmias, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands (R.E.K., L.A.D., A.-F.B.E.Q., T.F.B., A.d.W., N.R.B., W.v.d.S., J.A.d.V., K.M.K., S.P., A.A.M.W., L.R.A.O.N., L.S., L.V.A.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2360-984X","authenticated-orcid":true,"given":"Anne-Floor B.E.","family":"Quast","sequence":"additional","affiliation":[{"name":"Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart Failure &amp; Arrhythmias, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands (R.E.K., L.A.D., A.-F.B.E.Q., T.F.B., A.d.W., N.R.B., W.v.d.S., J.A.d.V., K.M.K., S.P., A.A.M.W., L.R.A.O.N., L.S., L.V.A.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8379-7470","authenticated-orcid":true,"given":"Tom F.","family":"Brouwer","sequence":"additional","affiliation":[{"name":"Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart Failure &amp; Arrhythmias, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands (R.E.K., L.A.D., A.-F.B.E.Q., T.F.B., A.d.W., N.R.B., W.v.d.S., J.A.d.V., K.M.K., S.P., A.A.M.W., L.R.A.O.N., L.S., L.V.A.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9055-9267","authenticated-orcid":true,"given":"Pier D.","family":"Lambiase","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University College London and Barts Heart Centre, London, United Kingdom (P.D.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J.","family":"Cassidy","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Trust, Blackpool, United Kingdom (C.J.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4591-4220","authenticated-orcid":true,"given":"Lucas V.A.","family":"Boersma","sequence":"additional","affiliation":[{"name":"Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart Failure &amp; 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(J.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Golovchiner","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel (G.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8959-8536","authenticated-orcid":true,"given":"Anouk","family":"de Weger","sequence":"additional","affiliation":[{"name":"Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart Failure &amp; Arrhythmias, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands (R.E.K., L.A.D., A.-F.B.E.Q., T.F.B., A.d.W., N.R.B., W.v.d.S., J.A.d.V., K.M.K., S.P., A.A.M.W., L.R.A.O.N., L.S., L.V.A.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc A.","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY (M.A.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2544-5279","authenticated-orcid":true,"given":"Jonas S.S.G.","family":"de Jong","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (J.S.S.G.d.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdul","family":"Ghani","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (A.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3122-1482","authenticated-orcid":true,"given":"Nigel","family":"Lewis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom (N.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7227-3428","authenticated-orcid":true,"given":"Eloi","family":"Marijon","sequence":"additional","affiliation":[{"name":"Division of Cardiology, European Georges Pompidou Hospital, Paris, France (E.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9792-3359","authenticated-orcid":true,"given":"Nick R.","family":"Bijsterveld","sequence":"additional","affiliation":[{"name":"Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart Failure &amp; Arrhythmias, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands (R.E.K., L.A.D., A.-F.B.E.Q., T.F.B., A.d.W., N.R.B., W.v.d.S., J.A.d.V., K.M.K., S.P., A.A.M.W., L.R.A.O.N., L.S., L.V.A.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7183-4278","authenticated-orcid":true,"given":"Pascal","family":"Defaye","sequence":"additional","affiliation":[{"name":"Service de Cardiologie, Centre Hospitalier Universitaire, Grenoble, France (P.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7755-3613","authenticated-orcid":true,"given":"Claire A.","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Papworth Hospital, Cambridge, United Kingdom (C.A.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duncan C.","family":"Field","sequence":"additional","affiliation":[{"name":"Cardiology, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, United Kingdom (D.C.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4892-4275","authenticated-orcid":true,"given":"Jan","family":"Elders","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Canisius Wilhelminahospital, Nijmegen, the Netherlands (J.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naushad A.","family":"Shaik","sequence":"additional","affiliation":[{"name":"Department of Cardiac Electrophysiology, Advent Health Orlando, Orlando, FL (N.A.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1280-7042","authenticated-orcid":true,"given":"Serge","family":"Boveda","sequence":"additional","affiliation":[{"name":"Heart Rhythm Department, Clinique Pasteur, Toulouse, France (S.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2236-3983","authenticated-orcid":true,"given":"Willeke","family":"van der Stuijt","sequence":"additional","affiliation":[{"name":"Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart Failure &amp; Arrhythmias, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands (R.E.K., L.A.D., A.-F.B.E.Q., T.F.B., A.d.W., N.R.B., W.v.d.S., J.A.d.V., K.M.K., S.P., A.A.M.W., L.R.A.O.N., L.S., L.V.A.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4200-8075","authenticated-orcid":true,"given":"Jolien A.","family":"de Veld","sequence":"additional","affiliation":[{"name":"Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart Failure &amp; Arrhythmias, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands (R.E.K., L.A.D., A.-F.B.E.Q., T.F.B., A.d.W., N.R.B., W.v.d.S., J.A.d.V., K.M.K., S.P., A.A.M.W., L.R.A.O.N., L.S., L.V.A.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3633-4486","authenticated-orcid":true,"given":"Kirsten M.","family":"Kooiman","sequence":"additional","affiliation":[{"name":"Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart Failure &amp; 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