Patient selection
All S-ICD placement indications in primary or secondary prevention were set as per the current ICD placement guidelines6. As per clinical practice in our centers, the combination of an S-ICD and an AAE is a procedure reserved for patients deemed at a very high-risk of infection. According to our routine, a very high-risk has been defined as the presence of at least 2 risk factors among the following: previous CIED infection requiring device extraction; diabetes mellitus (either type 1 or type 2) requiring insulin treatment; chronic kidney disease requiring hemodialysis or peritoneal dialysis; active malignancy; chronic disease leading to immunodeficiency disorders (i.e. advance HIV infection, congenital immunodeficiencies); chronic use of anticoagulant or immunosuppressant drugs (i.e. post-transplantation anti-rejection medications). Figure 1 presents the clinical algorithm used in our clinical practice. Even if no side effects or disadvantages for the patients have been reported with the use of the AAE have been reported so far, all patients were informed and educated about its placement and informed consent for the procedure was obtained in all cases.