Andrea Dell’aQuila

Catheter ablation is widely performed for the treatment of supraventricular and ventricular arrhythmias; however, specific recommendations regarding antibiotic prophylaxis for femoral-access procedures are lacking in current international guidelines, resulting in substantial practice variability. Although infectious complications are rare, severe events such as infective endocarditis and septic complications have been reported and are associated with significant morbidity and mortality. At the same time, increasing concerns regarding antimicrobial resistance challenge the indiscriminate use of prophylactic antibiotics in low-risk settings, underscoring the need for a more selective and rational approach. This narrative review summarizes the available evidence on infectious complications related to femoral-access catheter ablation and electrophysiological studies. In the absence of prospective data, indirect evidence and biological plausibility were integrated to inform clinical decision-making. Based on multidisciplinary collaboration, we propose a pragmatic, risk-based institutional protocol that discourages routine prophylaxis in low-risk patients while allowing selective antibiotic use in predefined high-risk scenarios. This framework aims to balance patient safety with antimicrobial stewardship and may help reduce unwarranted variability in contemporary electrophysiology practice.

(200 w) Introduction. Remote monitoring (RM) of cardiac implantable electronic device (CIED) diagnostics helps to identify patients potentially at risk of worsening heart failure (HF). Additionally, knowledge of patient HF-related symptoms is crucial for decision making. Patient smartphone applications may represent an ideal option to remotely collect this information. Purpose. To assess real-world HF patient access, acceptance, and adherence to use of an HF-dedicated smartphone application (HF app). Methods. In this study, 10 Italian hospitals administered a survey on smartphone/app use to HF patients with CIED. The subgroup who accepted it downloaded the HF app. Mean 1-year adherence of the HF app use was evaluated. Results. A total of 495 patients (67 ± 13 years, 79% males, 26% NYHA III–IV) completed the survey, of which 84% had access to smartphones and 85% were willing to use the HF app. In total, 311/495 (63%) downloaded the HF app. Patients who downloaded the HF app were younger and had higher school qualification. Patients who were ≥60 years old had higher mean 1-year adherence (54.1%) than their younger counterparts (42.7%; p < 0.001). Hospitals with RM-dedicated staff had higher mean 1-year patient adherence (64.0% vs. 33.5%; p < 0.001). Adherence to HF app decreased from 63.3% (weeks_1–13) to 42.2% (weeks_40–52, p < 0.001). Conclusions. High access and acceptance of smartphones/apps by HF patients with CIED allow HF app use for RM of patient signs/symptoms. Younger patients with higher school qualifications are more likely to accept HF app; however, older patients have higher long-term adherence.

Introduction: Permanent His bundle pacing (HBP) is the most physiological pacing modality, and new implantation systems are now available. The aim of the present study was to describe and compare four different techniques to perform HBP.Methods and results: We included all consecutive patients who underwent a HBP attempt in our initial experience between June 2020 and May 2022. The success and characteristics of the procedure were compared among four implantation techniques: the Biotronik Selectra 3D sheath with Solia S60 lead (Selectra 3D), the Boston Scientific Site Selective Pacing Catheter with Ingevity lead (SSPC), the Abbott steerable stylet locator with Tendril lead (Locator), and the use of a standard stylet manually pre‐shaped with a conventional pacing lead (Curved stylet). Ninety‐eight patients (median age 79 years [interquartile range, 73‐83], 83% men) were identified. The Selectra 3D technique was used in 43 procedures, SSPC in 26, Locator in 18 and Curved stylet in 11. The groups had similar clinical characteristics. Overall, procedural success was achieved in 91 patients (93%) with similar proportions among groups (p = .986). Fluoroscopy and procedural times were 6.0 (4.4‐8.5) and 60 (45‐75) min, respectively, without significant differences (p = .333 and p = .790). The rate of selective capture, the pacing threshold, and the paced QRS duration were also comparable. There was one pre‐discharge HBP lead dislodgment (1%) that required implant revision.Conclusion: In our experience, four techniques for HBP achieved comparable results in terms of safety and effectiveness. The availability of different systems may lead to widespread use of physiological pacing.

Leadless pacemaker implantation (LPI) has fewer device complications and reduced chance of infection compared to conventional pacemakers. Dextrocardia with situs viscerum inversus (DC+SVI) is a rare condition, which seldom leads to cardiac complications. However, its presence poses a challenge to operators in cardiac procedures. LPI reports in DC patients are scarce. We report a case of LPI in a DC+SVI patient, followed by a brief but comprehensive literature review.