皮下植入式心律转复除颤器治疗失败的风险：从PRAETORIAN评分到临床实践
The risk of failure of subcutaneous implantable cardioverter defibrillator therapy: from PRAETORIAN score to clinical practice.
作者信息
Ziacchi Matteo, Ottaviano Luca, Checchi Luca, Viani Stefano, Nigro Gerardo, Bianchi Valter, De Bonis Silvana, De Filippo Paolo, Francia Pietro, Rapacciuolo Antonio, Vitulano Gennaro, Perego Giovanni Battista, Schillaci Vincenzo, Lavalle Carlo, Migliore Federico, Pisanò Ennio C L, Compagnucci Paolo, Palmisano Pietro, Botto Gianluca, Rordorf Roberto, Lovecchio Mariolina, Valsecchi Sergio, Biffi Mauro
机构信息
Institute of Cardiology, IRCCS Azienda Ospedaliero Universitaria di Bologna, Via Massarenti n. 9, Bologna 40138, Italy.
Arrhythmia and Electrophysiology Unit, Cardiothoracic Department IRCCS Galeazzi-S. Ambrogio, Milan, Italy.
出版信息
Europace. 2025 Feb 5;27(2). doi: 10.1093/europace/euaf011.
AIMS
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.
METHODS AND RESULTS
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-anterior and lateral chest radiographs were analysed to calculate the PRAETORIAN score. A total of 95.7% of patients had a PRAETORIAN score < 90, indicative of a low risk of conversion failure. Body mass index (BMI) was the only independent predictor of a score ≥ 90, and all patients with BMI < 25 kg/m2 (normal weight or underweight) had a score < 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 > 88 Ohm enabled to detect a PRAETORIAN score ≥ 90 with 98% (95% CI 97-99%) negative predictive value.
CONCLUSION
In contemporary practice, the PRAETORIAN score can be simplified. By adopting an intermuscular approach, two of the three steps of the score-evaluating the adequate posterior positioning of the generator and measuring the sub-generator fat-become 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.
CLINICAL TRIAL REGISTRATION
URL: http://clinicaltrials.gov/ Identifier: NCT02275637.
目的
皮下植入式心律转复除颤器（S-ICD）是传统植入式心律转复除颤器（ICD）的一种替代方案。基于胸部X光片的PRAETORIAN评分已通过评估诸如线圈与胸骨之间的脂肪厚度和发生器位置等因素，被证实可预测S-ICD除颤测试成功的概率。本研究评估了PRAETORIAN评分与临床特征以及植入变量之间的相关性。
方法与结果
我们回顾性分析了来自33个中心的1253例接受S-ICD植入患者的数据。所有患者均采用脉冲发生器肌内定位。分析植入后前后位和侧位胸部X光片以计算PRAETORIAN评分。共有95.7%的患者PRAETORIAN评分<90，表明转复失败风险较低。体重指数（BMI）是评分≥90的唯一独立预测因素，所有BMI<25 kg/m²（正常体重或体重过轻）的患者评分均<90。肌内定位技术使所有患者的设备后位放置最佳，仅3%的病例发生器下方有明显脂肪。冲击阻抗值>88欧姆能够以98%（95%CI 97 - 99%）的阴性预测值检测到PRAETORIAN评分≥90。
结论
在当代实践中，PRAETORIAN评分可以简化。通过采用肌内方法，评分的三个步骤中的两个——评估发生器的适当后位放置和测量发生器下方脂肪——变得多余，并且阻抗可作为线圈下方脂肪厚度的可靠替代指标。此外，我们的数据表明，对于非肥胖患者，可确保获得良好的PRAETORIAN评分，使得评分评估可能没有必要。
临床试验注册
网址：http://clinicaltrials.gov/ 标识符：NCT02275637
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