Aims In patients undergoing cardiac implantable electronic device (CIED) intervention, routine pre-procedure antibiotic prophylaxis is recommended. A more powerful antibiotic protocol has been suggested in patients at high risk of infection. Stratification of individual infective risk could guide the prophylaxis before CIED procedure. Methods and results Patients undergoing CIED surgery were stratified according to the Shariff score in low and high infective risk. Patients in the ‘low-risk’ group were treated with only two antibiotic administrations while patients in the ‘high-risk’ group were treated with a prolonged 9-day protocol, according to renal function and allergies. We followed-up patients for 250 days with clinical outpatient visit and electronic control of the CIED. As primary endpoint, we evaluated CIED-related infections. A total of 937 consecutive patients were enrolled, of whom 735 were stratified in the ‘low-risk’ group and 202 in the ‘high-risk’ group. Despite different risk profiles, CIED-related infection rate at 250 days was similar in the two groups (8/735 in ‘low risk’ vs. 4/202 in ‘high risk’, P = 0.32). At multivariate analysis, active neoplasia, haematoma, and reintervention were independently associated with CIED-related infection (HR 5.54, 10.77, and 12.15, respectively). Conclusion In a large cohort of patients undergoing CIED procedure, an antibiotic prophylaxis based on individual stratification of infective risk resulted in similar rate of infection between groups at high and low risk of CIED-related infection.

Aims We sought to assess the atrial fibrillation/flutter (AF/AFL) mortality rates and relative trends among the Italian population between 2003 and 2017. Methods Data regarding the cause-specific mortality and population size by sex in 5-year age groups were extracted from the World Health Organization (WHO) global mortality database. Decedents reporting the codes I48 were extracted accordingly to the International Classification of Disease-10 (ICD-10) coding system. The age-adjusted mortality rates (AAMRs), with relative 95% confidence intervals (CIs), also stratified by sex, were determined using the direct method. Joinpoint regression analyses were used to identify periods with statistically distinct log linear trends in AF/AFL-related death rates. To calculate nationwide annual trends in AF/AFL-related mortality, we assessed the average annual percentage change (AAPC) and relative 95% CIs. Results Over the study period, 90 623 (57 109 females) AF-related deaths were recorded. The AF/AFL AAMR increased from 8.1 (95% CI: 7.8–8.2) deaths per 100 000 to 18.7 (16.9–20.0) deaths per 100 000 population. Joinpoint regression analysis revealed a linear increase in age-standardized AF/AFL-related mortality [AAPC: +3.6 (95% CI: 3.0–4.3, P < 0.0001)] in the entire Italian population. Moreover, the mortality rate increased with age, showing a seemingly exponential distribution with a similar trend between males and females. Although the increase was more pronounced among women [AAPC: +3.7 (95% CI: 3.1–4.3, P < 0.0001)] compared with men [AAPC: +3.4 (95% CI: 2.8–4.0, P < 0.0001)], the difference did not reach statistical significance (P = 0.16). Conclusions In Italy, the AF/AFL-related mortality rates linearly increased from 2003 to 2017.

Left ventricular noncompaction (LVNC) is a structural abnormality of the left ventricle, usually described as an isolated condition, or sometimes associated with other structural cardiac diseases. LVNC is generally asymptomatic, although it may present conduction disorders, arrhythmias, and heart failure. Here, we present the case of a patient who came to our attention with a severe LVNC phenotype associated with advanced AV conduction disorder, and supraventricular and ventricular arrhythmias at young age, in which a novel MIB1, likely pathogenic, variation has been identified.

The aim of this review is to identify possible structural abnormalities of BrS and their potential association with symptoms, risk stratification, and prognosis. (1) Background: BrS has always been considered a purely electrical disease and imaging techniques do not currently play a specific role in the diagnosis of this arrhythmic syndrome. Some authors have recently hypothesized the presence of structural and functional abnormalities. Therefore, several studies investigated the presence of pathological features in echocardiography and cardiac magnetic resonance imaging (MRI) in patients with BrS, but results were controversial. (2) Methods: We performed a systematic review of the literature on the spectrum of features detected by echocardiography and cardiac MRI. Articles were searched in Pubmed, Cochrane Library, and Biomed Central. Only papers published in English and in peer-reviewed journals up to November 2021 were selected. After an initial evaluation, 596 records were screened; the literature search identified 19 relevant articles. (3) Results: The imaging findings associated with BrS were as follows: right ventricular dilation, right ventricular wall motion abnormalities, delayed right ventricular contraction, speckle and feature tracking abnormalities, late gadolinium enhancement, and fat infiltration in the right ventricle. Furthermore, these features emerged more frequently in patients carrying the genetic mutation on the sodium voltage-gated channel α-subunit 5 (SCN5A) gene. (4) Conclusions: Specific imaging features detected by echocardiography and cardiac magnetic resonance are associated with BrS. However, this population appears to be heterogeneous and imaging anomalies emerged to be more frequent in patients carrying genetic mutations of SCN5A. Future studies with an evaluation of BrS patients are needed to identify the specific association linking the Brugada pattern, imaging abnormalities and their possible correlation with prognosis.