Background and Objectives: Cardiac implantable electronic device (CIED) infections remain among the most serious complications of pacemaker, implantable cardioverter-defibrillator, and cardiac resynchronization therapy procedures. They are associated with substantial morbidity, mortality, prolonged hospitalization, system extraction, long-term antimicrobial therapy, and increased healthcare costs. As most infections arise from perioperative contamination or procedure-related complications, prevention has become a major priority in contemporary electrophysiology practice. This review aimed to summarize current evidence on the prevention of CIED infections, with particular emphasis on modifiable risk factors and perioperative preventive measures. Materials and Methods: A focused narrative review was undertaken using targeted searches of PubMed/MEDLINE and Scopus, supplemented by major international guideline and consensus documents, with priority given to contemporary guidelines, randomised trials, meta-analyses, and major observational studies relevant to CIED infection prevention. Results: Prevention of CIED infection requires a structured, multifactorial approach spanning the entire procedural pathway. Key preventive strategies include careful reassessment of device indication, individualized device selection, correction of modifiable risk factors, postponement of elective implantation in the presence of active infection, appropriate perioperative antibiotic prophylaxis, and optimized management of anticoagulant and antiplatelet therapy to minimize pocket hematoma. Additional relevant measures include meticulous skin antisepsis, limitation of temporary invasive devices and unnecessary hardware, appropriate venous access selection, careful generator pocket creation and wound closure, and avoidance of early reintervention whenever feasible. Antibacterial envelopes may reduce major CIED infections in selected high-risk patients, whereas routine escalation of preventive measures without proven benefit is not supported. Conclusions: CIED infection prevention is inherently multifactorial and depends on the consistent application of evidence-based measures before, during, and after device implantation. Rigorous control of modifiable risk factors, prevention of pocket hematoma, appropriate antimicrobial prophylaxis, and meticulous procedural technique remain the cornerstones of effective infection prevention in patients undergoing CIED procedures.

Background and Objectives: Atrial fibrillation is a major cause of ischemic stroke, and in patients with non-valvular atrial fibrillation the left atrial appendage is the predominant site of thrombus formation. Although oral anticoagulation remains the standard strategy for stroke prevention, long-term therapy may be limited by bleeding risk, prior major bleeding, contraindications, intolerance, or difficulty maintaining stable anticoagulation. Endocardial left atrial appendage occlusion (LAAO) has therefore emerged as an alternative strategy in selected patients. Its role continues to evolve with expanding device technologies, contemporary direct oral anticoagulant therapy, and ongoing randomized evidence. Materials and Methods: This narrative literature review summarizes current evidence on endocardial LAAO, focusing on device design, anatomical considerations, clinical outcomes, postprocedural antithrombotic therapy, and ongoing research directions. Results: Available devices differ substantially in sealing mechanism, fixation strategy, conformability, surface properties, and suitability for complex appendage anatomy. The Watchman and Amulet platforms remain the most extensively studied systems, whereas several CE-marked and investigational devices aim to improve anatomical adaptability, reduce peri-device leak and device-related thrombus, and simplify implantation. Randomized evidence supports LAAO as a non-inferior alternative to oral anticoagulation in selected populations, with potential reduction in late bleeding but persistent concerns regarding procedural risk, frailty, comorbidity burden, and patient selection. The optimal postprocedural antithrombotic regimen remains uncertain, with increasing interest in individualized strategies and short-term direct oral anticoagulant therapy when feasible. Current research is shifting toward next-generation devices, combined ablation–closure strategies, simplified imaging guidance, and evaluation of LAAO as both an alternative and an adjunct to oral anticoagulation. Conclusions: LAAO should currently be considered a selective rather than a universal strategy, requiring individualized assessment of thromboembolic risk, bleeding risk, anatomy, procedural safety, and comorbidity burden.