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.