{"id":"34eea9995b04","type":"article","url":"https://hartvaat.nl/2026/04/25/praetorian-dft-defibrillatietest-bij-subcutane-icd-veilig-achterwege-te-laten/","title":"PRAETORIAN-DFT: defibrillatietest bij subcutane ICD veilig achterwege te laten","title_en":"","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.126.080638","source_url":"https://doi.org/https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.126.080638","authors":[],"significance":8,"published":"2026-05-09","source_date":"2026-04-25","image":"","kennis":["https://hartvaat.nl/kennis/ritmestoornissen/icd-implanteerbare-defibrillator/","https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"The multinational PRAETORIAN-DFT RCT randomised 965 subcutaneous ICD recipients across 37 centres to defibrillation testing versus no testing — using the PRAETORIAN score (based on chest X-ray) to assess implant position in the no-DFT arm. First-shock failure for spontaneous ventricular arrhythmias was non-inferior without DFT, with comparable mortality and revisions. Routine defibrillation testing can therefore be omitted in patients with a favourable PRAETORIAN score, reducing implant-related risk.","created":"2026-07-03T10:32:52Z","updated":"2026-07-03T13:31:48Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De multinationale PRAETORIAN-DFT-RCT randomiseerde 965 patiënten met een subcutane ICD naar wel of geen defibrillatietest, met de PRAETORIAN-score (op basis van thoraxröntgen) als alternatief om de positie te beoordelen. Het primaire eindpunt — falende eerste shock bij spontane ventriculaire ritmestoornissen — was niet-inferieur in de groep zonder defibrillatietest. Mortaliteit en S-ICD-revisies waren vergelijkbaar tussen de groepen. Routinematige defibrillatietest kan dus achterwege blijven bij patiënten met een gunstige PRAETORIAN-score, wat het implantatierisico verlaagt.","abstract_original":"Background: To improve survival in patients at risk of sudden cardiac death, subcutaneous ICDs (S-ICDs) require optimal implant positioning for effective shocks. Defibrillation (DF) testing is recommended but carries serious risks. The PRAETORIAN score predicts defibrillation outcomes based on chest X-rays. The PRAETORIAN-DFT trial evaluated whether omission of DF testing guided by the PRAETORIAN score is non-inferior for first-shock efficacy.Methods: In this multinational trial, S-ICD patients from 37 centers were randomized to DF testing or no DF testing. In the No-DF testing group, the PRAETORIAN score was evaluated before discharge. The primary endpoint was failed first shock for spontaneous ventricular arrhythmias, as a surrogate for defibrillation success, tested for non-inferiority with a 3% absolute risk margin. Secondary endpoints included mortality, potential DF testing-related complications, and S-ICD revisions.Results: The included 965 patients (No-DF testing, n=483;DF testing, n=482) were followed for a median of 41 months. Failed first shock for spontaneous ventricular arrhythmia occurred in 1.7% of the No-DF testing group versus 2.3% of the DF testing group (–0.6%, 95% CI [ –2.6 to 1.4]; p<0.001). There were no significant differences in all-cause mortality (HR 0.9 [95% CI 0.6–1.4]) or arrhythmic death (HR 0.4 [95% CI 0.04–3.4]). Potential DF testing-related complications occurred in 1.7% in the DF testing group. Postoperative S-ICD revisions due to inadequate positioning were identical between groups (n=2 each).Conclusions: PRAETORIAN score–guided omission of DF testing- after S-ICD implantation did not increase the risk of failed first shocks for spontaneous ventricular arrhythmias and reduced procedural risk without increasing S-ICD revisions. (Funded by Boston Scientific; PRAETORIAN-DFT)."}