Subcutaneous or Transvenous Defibrillator Therap

The PRAETORIAN trial was a randomized, noninferiority study comparing subcutaneous implantable cardioverter-defibrillators (S-ICDs) to transvenous ICDs in patients needing defibrillator therapy but not pacing. A total of 849 patients were randomized. Over a median follow-up of 49.1 months, the composite primary endpoint device-related complications or inappropriate shocks occurred in 15.1% of the S-ICD group and 15.7% of the transvenous group, confirming noninferiority (HR 0.99; 95% CI, 0.71–1.39). S-ICDs had fewer lead-related complications (1.4% vs. 6.6%), while inappropriate shocks were slightly more frequent (9.7% vs. 7.3%). Appropriate shocks occurred more often with S-ICDs (19.2% vs. 11.5%) due to lack of antitachycardia pacing. Overall, S-ICD therapy is a viable alternative to transvenous ICDs in eligible patients.

The PRAETORIAN trial was a randomized, noninferiority study comparing subcutaneous implantable cardioverter-defibrillators (S-ICDs) to transvenous ICDs in patients needing defibrillator therapy but not pacing. A total of 849 patients were randomized. Over a median follow-up of 49.1 months, the composite primary endpoint device-related complications or inappropriate shocks occurred in 15.1% of the S-ICD group and 15.7% of the transvenous group, confirming noninferiority (HR 0.99; 95% CI, 0.71–1.39). S-ICDs had fewer lead-related complications (1.4% vs. 6.6%), while inappropriate shocks were slightly more frequent (9.7% vs. 7.3%). Appropriate shocks occurred more often with S-ICDs (19.2% vs. 11.5%) due to lack of antitachycardia pacing. Overall, S-ICD therapy is a viable alternative to transvenous ICDs in eligible patients.