Predictive value of the PRAETORIAN score for defibrillation test success in patients with subcutaneous ICD: A subanalysis of the PRAETORIAN-DFT trial

Background: The PRAETORIAN score estimates the risk of failure of subcutaneous implantable cardioverter-defibrillator (S-ICD) therapy by using generator and lead positioning on bidirectional chest radiographs. The PRospective randomized compArative trial of subcutanEous implanTable cardiOverter-defibrillatoR ImplANtation with and without DeFibrillation Testing (PRAETORIAN-DFT) investigates whether PRAETORIAN score calculation is noninferior to defibrillation testing (DFT) with regard to first shock efficacy in spontaneous events. Objective: This prespecified subanalysis assessed the predictive value of the PRAETORIAN score for defibrillation success in induced ventricular arrhythmias. Methods: This multicenter investigator-initiated trial randomized 965 patients between DFT and PRAETORIAN score calculation after de novo S-ICD implantation. Successful DFT was defined as conversion of induced ventricular arrhythmia in <5 seconds from shock delivery within 2 attempts. Bidirectional chest radiographs were obtained after implantation. The predictive value of the PRAETORIAN score for DFT success was calculated for patients in the DFT arm. Results: In total, 482 patients were randomized to undergo DFT. Of these patients, 457 (95%) underwent DFT according to protocol, of whom 445 (97%) had successful DFT and 12 (3%) had failed DFT. A PRAETORIAN score of ≥90 had a positive predictive value of 25% for failed DFT, and a PRAETORIAN score of <90 had a negative predictive value of 99% for successful DFT. A PRAETORIAN score of ≥90 was the strongest independent predictor for failed DFT (odds ratio 33.77; confidence interval 6.13–279.95; P <.001). Conclusion: A PRAETORIAN score of <90 serves as a reliable indicator for DFT success in patients with S-ICD, and a PRAETORIAN score of ≥90 is a strong predictor for DFT failure

The predictive value of the PRAETORIAN score for defibrillation test success in subcutaneous ICD patients:a sub-analysis of the PRAETORIAN-DFT trial

BACKGROUND: The PRAETORIAN score estimates the risk of failure of subcutaneous implantable cardioverter defibrillator (S-ICD) therapy, using generator and lead positioning on bidirectional chest radiographs. The PRAETORIAN-DFT trial investigates whether PRAETORIAN score calculation is non-inferior to defibrillation testing (DFT), with regard to first shock efficacy in spontaneous events.OBJECTIVE: This pre-specified sub-analysis assesses the predictive value of the PRAETORIAN score for defibrillation success in induced ventricular arrhythmias.METHODS: This multicenter investigator initiated trial randomized 965 patients between DFT or PRAETORIAN score calculation after de novo S-ICD implant. Successful DFT was defined as conversion of an induced ventricular arrhythmia in less than five seconds from shock delivery, within two attempts. Bidirectional chest radiographs were obtained after implantation. Predictive value of the PRAETORIAN score for DFT success was calculated for patients in the DFT arm.RESULTS: In total, 482 patients were randomized to undergo DFT. Of these patients, 457 underwent DFT according to protocol, of whom 445 had a successful DFT and 12 had a failed DFT. A PRAETORIAN score ≥ 90 had a positive predictive value of 25% for failed DFT and a PRAETORIAN score &lt; 90 had a negative predictive value of 99% for successful DFT. A PRAETORIAN score ≥ 90 was the strongest independent predictor for failed DFT (OR 33.77; CI 6.13-279.95, p&lt;0.001).CONCLUSION: A PRAETORIAN score &lt;90 serves as a reliable indicator for DFT success in S-ICD patients and a PRAETORIAN score ≥90 is a strong predictor for DFT failure.</p

Using photo-elicitation to understand reasons for repeated self-harm: a qualitative study

Background: Reasons for self-harm are not well understood. One of the reasons for this is that first-hand accounts are usually elicited using traditional interview and questionnaire methods. This study aims to explore the acceptability of using an approach (photo-elicitation) that does not rely on solely verbal or written techniques, and to make a preliminary assessment of whether people can usefully employ images to support a discussion about the reasons why they self-harm. Method: Interviews with eight participants using photo elicitation, a method in which photographs produced by the participant are used as a stimulus and guide within the interview. Results: Participants responded positively to using images to support a discussion about their self-harm and readily incorporated images in the interview. Four main themes were identified representing negative and positive or adaptive purposes of self-harm: self-harm as a response to distress, self-harm to achieve mastery, self-harm as protective and self-harm as a language or form of communication. Conclusions: Employing this novel approach was useful in broadening our understanding of self-harm