Summary and general discussion 175 hypertension, antiplatelet use, nonsteroidal anti-inflammatory use, liver disease, and bleeding history. Integration of the PADIT-score into clinical practice and decision support tools enables the planning of proactive measures to mitigate potential infection, such as an antibacterial envelope, meticulous surgical technique, and postoperative surveillance. We demonstrated the usefulness of the PADIT score in the identification of patients at high risk for developing CIED infection, where an antibacterial envelope may have been useful. The 2019 EHRA consensus document recommends using an antibiotic envelope in patients exhibiting characteristics similar to those in the WRAP-IT study or presenting with other high-risk factors, in the context of the local incidence of CIED infections (34). It is important to note this latter aspect, as different centers have different standard-of-care infection rates depending on their patient populations and local preventive measures. The WRAP-IT trial demonstrated the efficacy and costeffectiveness of antibacterial envelopes in selected CIED populations (i.e., CRT procedures, CIED replacements and upgrades) (54, 55). Regrettably, in the Netherlands, reimbursement is lacking for the utilisation of an antibiotic envelope in CIED surgery, in contrast to other European countries. Other complications associated with CIED implantations, such as pneumothorax, cardiac perforation, lead dysfunction and lead-related endocarditis, can be related to the implantation of a transvenous lead. Most of these complications can be overcome by using novel devices such as subcutaneous ICDs and leadless pacemakers (34, 56, 57), which currently are used when a lack of a superior access exists (i.e., occluded superior veins). The PRAETORIAN trial has shown that subcutaneous ICDs are noninferior to transvenous ICDs with respect to device-related complications and inappropriate shocks (58). Thus, S-ICDs should be considered as an alternative to transvenous technologies. However, the higher costs of these novel devices require scrutiny to identify the patients who will benefit the most of these devices. Future studies will identify which patient groups are most suitable. 10
RkJQdWJsaXNoZXIy MTk4NDMw