Subcutaneous Defibrillator Implantation With or Without Defibrillation Test: The Primary Results of the Randomized PRAETORIAN-DFT Trial.

Omitting defibrillation testing guided by the PRAETORIAN score is noninferior, with a 1.7% failure rate, compared to testing in S-ICD implantation over 41 months.

• Why it matters: Avoiding defibrillation testing could reduce procedural risks without compromising shock efficacy, addressing concerns about testing-related complications in patients at risk of sudden cardiac death.
• What they did: The PRAETORIAN-DFT trial randomized 965 patients across 37 centers to undergo or skip defibrillation testing, evaluating first-shock success and safety outcomes over a median follow-up of 41 months.
• The result: Results showed no significant difference in first-shock failure, mortality, or device revisions between groups, supporting the safety of PRAETORIAN score-guided omission of defibrillation testing.