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Cardiac implantable electronic devices (CIEDs) offer the benefit of remote monitoring and decision making and find particular applications in special populations such as the elderly. Less transportation, reduced costs, prompt diagnosis, a sense of security, and continuous real-time monitoring are the main advantages. On the other hand, less physician–patient interactions and the technology barrier in the elderly pose specific problems in remote monitoring. CIEDs nowadays are abundant and are mostly represented by rhythm control/monitoring devices, whereas hemodynamic remote monitoring devices are gaining popularity and are evolving and becoming refined. Future directions include the involvement of artificial intelligence, yet disparities of availability, lack of follow-up data, and insufficient patient education are still areas to be improved. This review aims to describe the role of CIED in the very elderly and highlight the merits and possible drawbacks.

BackgroundAlthough previous studies showed that atrial high-rate episodes (AHREs) are associated with a higher risk of developing incident atrial fibrillation (AF) and thromboembolic events, their clinical significance is still unclear. The purpose of this study was to define whether there is any clinical impact on the occurrence of ischemic and hemorrhagic events in patients with AHREs and initiation of oral anticoagulation (OAC).MethodologyPatients with AHREs who had received cardiac implantable electronic devices (CIEDs, i.e., dual-chamber pacemaker [PM] or implantable cardioverter defibrillator [ICD]) were included in the study. OAC initiation was decided by the assistant doctor. Patients who received OACs comprised the OAC group, while patients who were not referred for OAC initiation were included in the control group. The primary endpoint was the time to the event of the occurrence of thromboembolic events (thromboembolic event-free survival).ResultsA total of 154 individuals (77 in each group) were enrolled in the study, with a mean age of 72.5 years. The mean follow-up period for the OAC group was 19.1 months and for the control group, 18.9 months (P = 0.9). Thromboembolic events were noticed only in seven patients. Six of them were in the control group, and only one in the OAC group (P = 0.05). Major bleeding events were noticed in five patients, one of whom was in the control group and the rest in the OAC group (P = 0.17).ConclusionsOAC therapy in patients with AHREs was not associated with a significant difference in the risk of thromboembolic and bleeding events. Baseline patient characteristics and AHRE duration may be useful to intensify the monitoring and management of patients with AHREs. Bleeding events may be indicators of cancer in patients with AHREs receiving OACs.

Abstract Disclosure: D. Raptis: None. S. Chiotis: None. M. Shah: None. E. Bekiari: None. N. Bloomgarden: None. A. Tsapas: None. T. Karagiannis: None. Introduction: Insulin therapy plays an important role in the management of type 2 diabetes mellitus (T2DM) as the disease progresses. To improve patient adherence and convenience, once-weekly basal insulin analogs such as insulin icodec and insulin Fc have been developed. This systematic review and meta-analysis assessed the efficacy and safety of once-weekly basal insulin compared to daily basal insulin in people with T2DM. Methods: We searched PubMed and Cochrane Library up to December 4th, 2024. We did random-effects meta-analyses and calculated mean differences (MDs) for change in HbA1c, body weight, fasting plasma glucose (FPG) and time in range (TIR), as well as odds ratios (ORs) for achieving an Hba1c <7.0%, and for incidence of hypoglycemia. Results: The search identified 4,859 records, with 11 randomized controlled trials (5,976 participants) deemed eligible for inclusion. Seven studies recruited insulin-naive patients. Once-weekly basal insulin reduced HbA1c 0.12% (95% CI, -0.20 to -0.05) more compared to daily basal insulin, independent of insulin naivety status. Similarly, patients treated with once-weekly basal insulin achieved higher mean TIR change (MD 3.722; 95% CI, 2.36 to 5.09) and HbA1c<7.0% (OR 4.15; 95% CI, 2.77; 6.23) compared to people treated with daily basal insulin, yet with higher odds for any hypoglycemia (OR 1.72; 95% CI, 1.10; 2.71). Mean changes in body weight and in FPG were similar between the two groups. Conclusion: This meta-analysis demonstrates significant improvements in HbA1c and TIR with once-weekly basal insulin in T2DM at the cost of more hypoglycemic events. There was no difference in the benefit of weekly insulin on HbA1c reduction, in regards to insulin naivety status. Presentation: Monday, July 14, 2025

Background Brugada Syndrome (BrS) is a life-threatening cardiac arrhythmia disorder associated with an increased risk of ventricular arrhythmias (VAs) and sudden cardiac death. Current management primarily relies on implantable cardioverter-defibrillators (ICDs), but patients may experience ICD shocks. Catheter ablation (CA) has emerged as a potential intervention to target the arrhythmogenic substrate. This systematic review aims to evaluate the safety and efficacy of CA in BrS patients. Methods and results Studies with BrS patients undergoing CA for VAs were included. Fourteen studies that involved a total population of 709 BrS patients, with CA performed in 528 of them, were included. CA resulted in the non-inducibility of VAs in 91% (95% CI: 83–99, I2 = 76%) and resolution of type 1 ECG Brugada pattern in 88% (95% CI: 81–96.2, I2 = 91%) of the patients. After a mean follow-up of 30.7 months, 87% (95% CI: 80–94, I2 = 82%) of patients remained free from VAs. The incidence of VAs during follow-up was significantly lower in the ablation cohort in comparison to the group receiving only ICD therapy (OR = 0.03, 95% CI: 0.01–0.12, I2 = 0%). Conclusion CA shows potential as a therapeutic approach to reduce VAs and improve outcomes in BrS patients. While further research with a long follow-up period is required to confirm these findings, it represents a valuable tool as an add-on intervention to ICD implantation in BrS patients with a high burden of VAs. Graphical Abstract Graphical Abstract

Background Brugada Syndrome (BrS) is a life-threatening cardiac arrhythmia disorder associated with an increased risk of ventricular arrhythmias (VAs) and sudden cardiac death. Current management primarily relies on implantable cardioverterdefibrillators (ICDs), but patients may experience ICD shocks. Catheter ablation (CA) has emerged as a potential intervention to target the arrhythmogenic substrate. This systematic review aims to evaluate the safety and efficacy of CA in BrS patients. Methods and results Studies with BrS patients undergoing CA for VAs were included. Fourteen studies that involved a total population of 709 BrS patients, with CA performed in 528 of them, were included. CA resulted in the non-inducibility of VAs in 91% (95% CI: 83-99, [l.sup.2] = 76%) and resolution of type 1 ECG Brugada pattern in 88% (95% CI: 81-96.2, [l.sup.2] = 91%) of the patients. After a mean follow-up of 30.7 months, 87% (95% CI: 80-94, [l.sup.2] = 82%) of patients remained free from VAs. The incidence of VAs during follow-up was significantly lower in the ablation cohort in comparison to the group receiving only ICD therapy (OR = 0.03, 95% CI: 0.01-0.12, [l.sup.2] = 0%). Conclusion CA shows potential as a therapeutic approach to reduce VAs and improve outcomes in BrS patients. While further research with a long follow-up period is required to confirm these findings, it represents a valuable tool as an add-on intervention to ICD implantation in BrS patients with a high burden of VAs. Keywords Brugada Syndrome * Sudden cardiac death * Catheter ablation * Systematic review * Meta-analysis