Summary
This issue of Clinical Evidence explores recent advances across cardiac implantable devices, from ICD therapy in contemporary heart failure management to S-ICD implantation and insertable cardiac monitoring.
We begin with a new analysis from the EMPEROR-Reduced trial evaluating ICD/CRT-D therapy in patients with HFrEF receiving contemporary guideline-directed medical therapy. The findings reinforce the continued role of ICD therapy in reducing sudden cardiac death, even as heart failure pharmacological treatment continues to evolve.
We then review two proof-of-concept studies exploring practical approaches to simplify PRAETORIAN score assessment during S-ICD implantation. Fluoroscopy-based intraprocedural scoring and ultrasound-guided positioning and lead-depth assessment offer potential strategies for real-time evaluation of implant quality.
Finally, we examine a large multicenter, multidevice comparison of implantable loop recorders. The study highlights meaningful differences in diagnostic accuracy and false-positive burden across currently available ILRs, with LUX-Dx demonstrating the strongest overall performance among the evaluated devices.
We conclude with new evidence on ICD battery longevity, showing longer estimated longevity for Boston Scientific transvenous devices compared with other manufacturers.
Key Takeaways
- ICDs Still Matter in Contemporary HFrEF Era: A propensity score-matched analysis from EMPEROR-Reduced reinforces the continued value of ICD/CRT-D therapy for sudden cardiac death prevention in contemporary HFrEF patients. ICD therapy was associated with lower rates of sudden cardiac death regardless of empagliflozin treatment, although no significant reduction in all-cause mortality was observed.¹
- S-ICD Implant Workflow: From PRAETORIAN DFT to Simplified Score Assessment: Two proof-of-concept studies explored approaches to bring implant quality assessment into the S-ICD procedure itself. Intraprocedural PRAETORIAN scoring using fluoroscopy showed complete agreement with post-procedural assessment, while ultrasound-guided positioning demonstrated the feasibility of real-time system positioning and lead-depth evaluation.²˒³
- ILRs Performance in Arrhythmia Detection: A multicenter comparison involving 1,140 patients and 25,826 alerts demonstrated substantial differences in performance across four currently available ILR platforms. LUX-Dx achieved the highest overall diagnostic accuracy and was associated with the lowest false-positive burden, potentially supporting greater diagnostic confidence and more efficient device-clinic workflows.⁴
- ICD Battery Longevity Breaking News: A large analysis of CRT-Ds and transvenous ICDs found that Boston Scientific devices demonstrated longer estimated battery longevity compared with other manufacturers. In the CRT-D analysis, Boston Scientific battery longevity was approximately 2–3 years longer, while analyses of single- and dual-chamber ICDs also showed the longest estimated longevity for Boston Scientific devices.5
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