Chapter 10 170 treatment. The SELECT trial has previously demonstrated that in patients with preexisting cardiovascular disease and obesity, the prescribing of semaglutide improved cardiovascular outcomes (22). The DUTCH-WAIST trial aims to evaluate whether semaglutide reduces AF burden in obese patients (NCT06184633). The future will tell whether GLP1 agonists will become part of the therapeutic arsenal in obese patients with AF. Part II – Evaluation of complication rates in device therapy Summary Cardiac implantable electronic devices (CIED) are used to treat impulse and conduction abnormalities, ventricular arrhythmias, and heart failure. CIEDs include pacemakers, leadless pacemakers, ICDs, and cardiac resynchronization therapy (CRT) using biventricular pacing or conduction system pacing (CSP). Growing numbers of pacemaker and ICD implantations can be observed due to increasing life expectancy and growing age of the population (23, 24). This is also observed in the Netherlands, with 14,570 pacemaker interventions in 2022. However, the number of ICD interventions has remained relatively stable with 5,664 ICD interventions in 2022, with up to 40% for secondary prevention (25). The indications for a pacemaker are most commonly sinus node dysfunction and high-degree atrioventricular block. Over 80% of implanted pacemakers are in patients >65 years. An ICD is usually indicated in patients for secondary prevention of sudden cardiac death, or for primary prevention in heart failure patients with a left ventricular ejection fraction of ≤35% (24). Finally, CRT is indicated in patients with chronic heart failure with severe LV dysfunction and left bundle branch block (LBBB). By correcting the electromechanical desynchrony caused by LBBB, positive LV remodelling is possible. This has resulted in significant improvement in morbidity and mortality in patients with heart failure and LBBB (23). Both pacemakers and ICDs are considered low-risk procedures, but nonetheless are still associated with complications such as bleeding, infection, pneumothorax, and lead dislocation (23, 24). To minimise the risk of infection, preventive measures such as antibiotics prophylaxis, experienced and certified staff, sterile environment, periprocedural haemostatic agents, antibacterial envelopes and post-procedural pressure bandages are essential (26). Prevention of pocket hematoma is important,
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