Subcutaneous vs. Transvenous Implantable Cardioverter–Defibrillator: Which Is Better?

Transvenous implantable cardioverter–defibrillators (ICDs) have been proven to improve mortality in multiple randomized, controlled trials over the last 20 years. Subcutaneous ICDs are newer and not as well tested; concern has been raised about whether they would offer the same survival benefit as transvenous ICDs. Now, researchers have reported results from a long-awaited manufacturer-funded, controlled, noninferiority trial (PRAETORIAN; NCT01296022), which randomized 849 patients with indications for ICD implantation to the subcutaneous or the transvenous ICD.

Conditions that would benefit from pacing, including sinus bradycardia, ventricular tachycardia that could be terminated by antitachycardia pacing, or heart failure with an indicatio…