EP Trials Review
Prospective Randomized Comparison of Subcutaneous and Transvenous Implantable Cardioverter Defibrillator Therapy (PRAETORIAN) trial
Ref: PRAETORIAN Trial. NEJM 2020.
The subcutaneous implantable cardioverter–defibrillator (sqICD) was designed to avoid complications related to the transvenous ICD lead by using an entirely extrathoracic placement. However, the extrathoracic placement makes it impossible for the device to deliver pacing therapy.
Example of a CXR of a patient with an entirely subcutaneous ICD.
PRAETORIAN trial is the first RCT on sqICD. It is designed as a non-inferiority trial comparing safety endpoints of sqICD vs. conventional transvenous ICD. The trial enrolled 849 patients with indication for ICD therapy without the need for pacing therapy.
sqICD was noninferior to the transvenous ICD with respect to device-related complications and inappropriate shocks.

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