Intraoperative Application of the PRAETORIAN Score to Predict Optimal Subcutaneous Implantable Cardioverter-Defibrillator Placement.

Authors

Ken Yamazaki, Shingo Sasaki, Hiroaki Yokoyama, Yuji Ishida, Shogo Hamaura, Yuichi Toyama, Masaomi Kimura, Hirofumi Tomita

Published in

Journal of arrhythmia. Volume 42. Issue 5. Pages e70496. Epub Oct 11, 2026.

Abstract

The PRAETORIAN score (PS) estimates the risk of defibrillation failure after subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation based on postoperative chest radiography in the standing position. However, the usefulness of assessing the PS in the supine position intraoperatively has not yet been established.
We evaluated conventional (standing) and intraoperative supine PS in 124 consecutive Japanese patients undergoing S-ICD implantation. Changes between conventional and supine PS values were analyzed in two ways: (1) the presence of any difference in the absolute PS values regardless of the risk category, and (2) changes in clinically relevant risk categories for conversion failure (low, intermediate, or high risk). Predictors of discordance between the two assessments were also investigated.
The median conventional PS was 30; 116 and 8 patients were classified as having low and intermediate risk of conversion failure, respectively. Numerical differences between the conventional and supine PS values were observed in 13 patients. However, clinically meaningful risk reclassification occurred in only two patients, suggesting that intraoperative supine PS assessment may underestimate PRAETORIAN score-based risk classification in a small subset of patients. Among patients with numerical PS changes, supine PS was significantly lower than conventional PS. An elevated BMI was strongly associated with PS discordance. Exploratory receiver operating characteristic curve analysis identified a BMI cutoff of 25.6 kg/m² for discriminating patients with numerical PS discordance.
Intraoperative supine PS assessment shows excellent concordance with conventional standing PS and may provide a practical tool for confirming appropriate system positioning in most Japanese patients.

PMID:
42865637
Bibliographic data and abstract were imported from PubMed on 13 Oct 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.