A novel tool to evaluate the implant position and predict defibrillation success of the subcutaneous implantable cardioverter-defibrillator: The PRAETORIAN score
Suboptimal positioning of the subcutaneous implantable cardioverter-defibrillator (S-ICD) increases the defibrillation threshold and risk of conversion failure. Our objective is to develop a tool to evaluate the implant position and predict defibrillation success of the S-ICD: the PRAETORIAN score....
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| Veröffentlicht in: | Heart rhythm 2019-03, Vol.16 (3), p.403-410 |
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| creator | Quast, Anne-Floor B.E. Baalman, Sarah W.E. Brouwer, Tom F. Smeding, Lonneke Wilde, Arthur A.M. Burke, Martin C. Knops, Reinoud E. |
| description | Suboptimal positioning of the subcutaneous implantable cardioverter-defibrillator (S-ICD) increases the defibrillation threshold and risk of conversion failure.
Our objective is to develop a tool to evaluate the implant position and predict defibrillation success of the S-ICD: the PRAETORIAN score.
The PRAETORIAN score is based on clinical and computer modeling knowledge of determinants affecting the defibrillation threshold: subcoil fat, subgenerator fat, and anterior positioning of the S-ICD generator. The score evaluates these determinants on the postoperative anterior-posterior and lateral chest radiographs and has 3 categories: 30– |
| doi_str_mv | 10.1016/j.hrthm.2018.09.029 |
| format | Article |
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Our objective is to develop a tool to evaluate the implant position and predict defibrillation success of the S-ICD: the PRAETORIAN score.
The PRAETORIAN score is based on clinical and computer modeling knowledge of determinants affecting the defibrillation threshold: subcoil fat, subgenerator fat, and anterior positioning of the S-ICD generator. The score evaluates these determinants on the postoperative anterior-posterior and lateral chest radiographs and has 3 categories: 30–<90 points representing a low risk, 90–<150 points representing an intermediate risk, and ≥150 points representing a high risk of conversion failure. The score was developed using 2 separate S-ICD data sets for derivation and validation. The performance metrics are the positive and negative predictive values.
The development data set consisted of 181 patients with S-ICD, and the validation cohort consisted of 321 patients from the S-ICD Investigational Device Exemption trial. The distribution of scores was 93%–98% low risk (<90 points), 2%–5% intermediate risk (90–<150 points), and 1% high risk (≥150 points). The positive predictive value for an intermediate or high PRAETORIAN score for a failed conversion test was 51%, while a low PRAETORIAN score predicted a successful conversion in 99.8% of patients.
The PRAETORIAN score allows the identification of patients with high defibrillation thresholds by using the routine chest radiograph and provides feedback to implanters on S-ICD positioning. The PRAETORIAN-DFT trial will prospectively validate the score by randomizing to standard conversion testing vs using the score without conversion testing.</description><identifier>ISSN: 1547-5271</identifier><identifier>EISSN: 1556-3871</identifier><identifier>DOI: 10.1016/j.hrthm.2018.09.029</identifier><identifier>PMID: 30292861</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Conversion testing ; Defibrillation testing ; Implantation ; Subcutaneous implantable cardioverter-defibrillator</subject><ispartof>Heart rhythm, 2019-03, Vol.16 (3), p.403-410</ispartof><rights>2018 Heart Rhythm Society</rights><rights>Copyright © 2018 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c425t-1dba01498c15b60d865fa5891b8a85b6d29d70404d1fd75b7aad8822852156443</citedby><cites>FETCH-LOGICAL-c425t-1dba01498c15b60d865fa5891b8a85b6d29d70404d1fd75b7aad8822852156443</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1547527118310129$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30292861$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Quast, Anne-Floor B.E.</creatorcontrib><creatorcontrib>Baalman, Sarah W.E.</creatorcontrib><creatorcontrib>Brouwer, Tom F.</creatorcontrib><creatorcontrib>Smeding, Lonneke</creatorcontrib><creatorcontrib>Wilde, Arthur A.M.</creatorcontrib><creatorcontrib>Burke, Martin C.</creatorcontrib><creatorcontrib>Knops, Reinoud E.</creatorcontrib><title>A novel tool to evaluate the implant position and predict defibrillation success of the subcutaneous implantable cardioverter-defibrillator: The PRAETORIAN score</title><title>Heart rhythm</title><addtitle>Heart Rhythm</addtitle><description>Suboptimal positioning of the subcutaneous implantable cardioverter-defibrillator (S-ICD) increases the defibrillation threshold and risk of conversion failure.
Our objective is to develop a tool to evaluate the implant position and predict defibrillation success of the S-ICD: the PRAETORIAN score.
The PRAETORIAN score is based on clinical and computer modeling knowledge of determinants affecting the defibrillation threshold: subcoil fat, subgenerator fat, and anterior positioning of the S-ICD generator. The score evaluates these determinants on the postoperative anterior-posterior and lateral chest radiographs and has 3 categories: 30–<90 points representing a low risk, 90–<150 points representing an intermediate risk, and ≥150 points representing a high risk of conversion failure. The score was developed using 2 separate S-ICD data sets for derivation and validation. The performance metrics are the positive and negative predictive values.
The development data set consisted of 181 patients with S-ICD, and the validation cohort consisted of 321 patients from the S-ICD Investigational Device Exemption trial. The distribution of scores was 93%–98% low risk (<90 points), 2%–5% intermediate risk (90–<150 points), and 1% high risk (≥150 points). The positive predictive value for an intermediate or high PRAETORIAN score for a failed conversion test was 51%, while a low PRAETORIAN score predicted a successful conversion in 99.8% of patients.
The PRAETORIAN score allows the identification of patients with high defibrillation thresholds by using the routine chest radiograph and provides feedback to implanters on S-ICD positioning. The PRAETORIAN-DFT trial will prospectively validate the score by randomizing to standard conversion testing vs using the score without conversion testing.</description><subject>Conversion testing</subject><subject>Defibrillation testing</subject><subject>Implantation</subject><subject>Subcutaneous implantable cardioverter-defibrillator</subject><issn>1547-5271</issn><issn>1556-3871</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp9Uc1u1DAQthCIlsITICEfuSR4nDhxkDisqgKVKoqq5Ww59kTrVRIH21mJx-FN8e62iBMXezT-fjzzEfIWWAkMmg_7chfSbio5A1myrmS8e0YuQYimqGQLz4913RaCt3BBXsW4ZxnRsOoluahyxWUDl-T3hs7-gCNN3h8Pigc9rjohTTukblpGPSe6-OiS8zPVs6VLQOtMohYH1wc3jvr0FFdjMEbqhxM1rr1Zk57Rr_FJR_cjUqODddkyJAzFPxo-fKTbTPz-sLnZ3j_cbr7RaHzA1-TFoMeIbx7vK_Lj8832-mtxd__l9npzV5iai1SA7TWDupMGRN8wKxsxaCE76KWWuWN5Z1tWs9rCYFvRt1pbKTmXgoNo6rq6Iu_PukvwP1eMSU0uGsxfO82gOECbkZxDhlZnqAk-xoCDWoKbdPilgKljNmqvTtmoYzaKdSrvO7PePRqs_YT2L-cpjAz4dAZgHvPgMKhoHM4mrzugScp691-DP8Uso9U</recordid><startdate>201903</startdate><enddate>201903</enddate><creator>Quast, Anne-Floor B.E.</creator><creator>Baalman, Sarah W.E.</creator><creator>Brouwer, Tom F.</creator><creator>Smeding, Lonneke</creator><creator>Wilde, Arthur A.M.</creator><creator>Burke, Martin C.</creator><creator>Knops, Reinoud E.</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201903</creationdate><title>A novel tool to evaluate the implant position and predict defibrillation success of the subcutaneous implantable cardioverter-defibrillator: The PRAETORIAN score</title><author>Quast, Anne-Floor B.E. ; Baalman, Sarah W.E. ; Brouwer, Tom F. ; Smeding, Lonneke ; Wilde, Arthur A.M. ; Burke, Martin C. ; Knops, Reinoud E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c425t-1dba01498c15b60d865fa5891b8a85b6d29d70404d1fd75b7aad8822852156443</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Conversion testing</topic><topic>Defibrillation testing</topic><topic>Implantation</topic><topic>Subcutaneous implantable cardioverter-defibrillator</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Quast, Anne-Floor B.E.</creatorcontrib><creatorcontrib>Baalman, Sarah W.E.</creatorcontrib><creatorcontrib>Brouwer, Tom F.</creatorcontrib><creatorcontrib>Smeding, Lonneke</creatorcontrib><creatorcontrib>Wilde, Arthur A.M.</creatorcontrib><creatorcontrib>Burke, Martin C.</creatorcontrib><creatorcontrib>Knops, Reinoud E.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Heart rhythm</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Quast, Anne-Floor B.E.</au><au>Baalman, Sarah W.E.</au><au>Brouwer, Tom F.</au><au>Smeding, Lonneke</au><au>Wilde, Arthur A.M.</au><au>Burke, Martin C.</au><au>Knops, Reinoud E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A novel tool to evaluate the implant position and predict defibrillation success of the subcutaneous implantable cardioverter-defibrillator: The PRAETORIAN score</atitle><jtitle>Heart rhythm</jtitle><addtitle>Heart Rhythm</addtitle><date>2019-03</date><risdate>2019</risdate><volume>16</volume><issue>3</issue><spage>403</spage><epage>410</epage><pages>403-410</pages><issn>1547-5271</issn><eissn>1556-3871</eissn><abstract>Suboptimal positioning of the subcutaneous implantable cardioverter-defibrillator (S-ICD) increases the defibrillation threshold and risk of conversion failure.
Our objective is to develop a tool to evaluate the implant position and predict defibrillation success of the S-ICD: the PRAETORIAN score.
The PRAETORIAN score is based on clinical and computer modeling knowledge of determinants affecting the defibrillation threshold: subcoil fat, subgenerator fat, and anterior positioning of the S-ICD generator. The score evaluates these determinants on the postoperative anterior-posterior and lateral chest radiographs and has 3 categories: 30–<90 points representing a low risk, 90–<150 points representing an intermediate risk, and ≥150 points representing a high risk of conversion failure. The score was developed using 2 separate S-ICD data sets for derivation and validation. The performance metrics are the positive and negative predictive values.
The development data set consisted of 181 patients with S-ICD, and the validation cohort consisted of 321 patients from the S-ICD Investigational Device Exemption trial. The distribution of scores was 93%–98% low risk (<90 points), 2%–5% intermediate risk (90–<150 points), and 1% high risk (≥150 points). The positive predictive value for an intermediate or high PRAETORIAN score for a failed conversion test was 51%, while a low PRAETORIAN score predicted a successful conversion in 99.8% of patients.
The PRAETORIAN score allows the identification of patients with high defibrillation thresholds by using the routine chest radiograph and provides feedback to implanters on S-ICD positioning. The PRAETORIAN-DFT trial will prospectively validate the score by randomizing to standard conversion testing vs using the score without conversion testing.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30292861</pmid><doi>10.1016/j.hrthm.2018.09.029</doi><tpages>8</tpages></addata></record> |
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| subjects | Conversion testing Defibrillation testing Implantation Subcutaneous implantable cardioverter-defibrillator |
| title | A novel tool to evaluate the implant position and predict defibrillation success of the subcutaneous implantable cardioverter-defibrillator: The PRAETORIAN score |
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