Transvenous or Subcutaneous ICD — Similar but Different

The results of the long-awaited Prospective Randomized Comparison of Subcutaneous and Transvenous Implantable Cardioverter Defibrillator Therapy (PRAETORIAN) trial — a randomized, controlled trial comparing transvenous implantable cardioverter–defibrillators (ICDs) with subcutaneous ICDs — are reported in this issue of the Journal.1 The transvenous ICD, developed in the 1980s, is implanted in the prepectoral area with the use of a transvenous lead that is inserted through the axillary or subclavian vein and advanced to the right ventricle. Randomized, controlled trials in the 1990s2,3 showed a significant survival benefit in patients who had these devices implanted after cardiac arrest because of sustained ventricular . . .