ICD Shocks with Subcutaneous vs. Transvenous Implantable Cardioverter Defibrillator

Antitachycardia pacing (ATP) in a transvenous implantable cardioverter defibrillator (TV-ICD) offers the opportunity to treat monomorphic ventricular tachycardia (VT) without an ICD shock. Whether ATP truly reduces ICD shocks was evaluated in the manufacturer-funded PRAETORIAN trial (NCT01296022), which randomized 849 patients with an indication for an ICD to TV-ICD or subcutaneous ICD (S-ICD). The primary analysis showed noninferiority of S-ICD to TV-ICD for inappropriate shocks and complications (NEJM JW Cardiol Sep 2020; p. 72 and N Engl J Med 2020; 383:526). The current prespecified secondary analysis compares the treatment of arrhythmias in the two groups.

During a median follow-up of approximately 4 years, the proportion of patients wh…