Conventional temporary epicardial pacing wires (TPWs) are widely used for postoperative pacing support but pose risks of several complications due to their non-biodegradable nature. Here we present a fully bioresorbable epicardial pacing lead composed of a pure zinc (Zn) core and a bioresorbable polymer insulation coating, fabricated using a simple and scalable dip-coating method. Zn-based leads demonstrated reliable pacing performance over a 4-week period in a rabbit model, comparable to clinical benchmarks. Comprehensive evaluations of their degradation behavior and tissue response in animal models revealed stable bioresorption and acceptable biocompatibility during and after the therapeutic period. This bioresorbable design eliminates the risks associated with non-degradable TPWs, while maintaining therapeutic efficacy and biocompatibility. With its unique combination of performance, safety, and adaptability, the Zn-polymer pacing lead represents a transformative step toward the next generation of TPWs, offering a safer and more effective alternative for managing postoperative cardiac pacing.

Background: Colchicine is commonly used early after atrial fibrillation (AF) ablation to reduce inflammation and reduce AF recurrence, but there is limited long-term efficacy data. Objective: To evaluate the effect of low dose colchicine use on long-term AF recurrence after AF ablation. Methods: From 2013 to 2021, all AF ablations performed at a single tertiary care medical center were analyzed for colchicine use, clinical and procedural characteristics, and AF recurrence. The colchicine dose was 0.3-0.6 mg once daily for 30 days. The primary outcome was AF recurrence, defined as AF detection for more than 30 seconds after a three-month blanking period. Propensity score matching (PSM, 1:1 match) was performed using covariates that were significant predictors of AF recurrence in prior studies. The minimum duration of follow-up was 6 months. Kaplan-Meier analysis was conducted to assess time to AF recurrence in the entire cohort and the PSM cohort. Results: The study population consisted of 1568 AF ablations in 1412 patients (67% male, age 65 ± 7 years and mean follow up 34 ± 14 months); 78% of the patients received colchicine. Colchicine use was associated with decreased AF recurrence (HR 0.78, CI 0.63-0.96, p=0.022). After PSM there were 275 patients in each group. AF recurrence was lower with colchicine (HR 0.71, CI 0.53-0.96, p=0.026). Conclusions: Low dose colchicine use was associated with lower long-term AF recurrence after AF ablation. A randomized, placebo-controlled trial is warranted to confirm if low dose colchicine should be used routinely after AF ablation.

BACKGROUND:Lyme carditis may cause complete heart block (CHB) usually at the level of the atrioventricular node, but rarely other arrhythmias. CASE SUMMARY:A 34-year-old man presented with chest pain and shortness of breath. An electrocardiogram revealed CHB. He had an episode of polymorphic ventricular tachycardia (PMVT) arrest requiring extracorporeal membrane oxygenation. A temporary transvenous pacemaker was inserted. Lyme IgM antibodies were positive; the patient was treated with antibiotics. Despite administration of antiarrhythmic agents, PMVT recurred. A subcutaneous implantable cardioverter-defibrillator was ultimately implanted. DISCUSSION:This case highlights a rare presentation of Lyme carditis resulting in CHB with subsequent PMVT and severe biventricular failure necessitating mechanical circulatory support. The literature suggests that patients usually have resolution on antibiotic therapy with pacing rarely needed. Temporary pacing bridged our patient, and a subcutaneous implantable cardioverter-defibrillator was implanted because of recurrent PMVT. TAKE-HOME MESSAGE:PMVT and cardiogenic shock are rare complications of Lyme carditis.

With advances in technology and technique, catheter ablation has achieved increasing safety and efficacy in arrhythmia treatment. Simultaneously, innovations have been developed to expedite patient throughput and reduce cost – for example, same-day discharge (SDD) after atrial fibrillation (AF) ablation.1Deyell M.W. Leather R.A. Macle L. et al.Efficacy and safety of same‐day discharge for atrial fibrillation ablation.JACC Clin Electrophysiol. 2020; 6: 609-619Crossref PubMed Scopus (0) Google Scholar, 2Jafry A.H. Akhtar K.H. Khan J.A. et al.Safety and feasibility of same-day discharge for catheter ablation of atrial fibrillation: a systematic review and meta-analysis.J Interv Card Electrophysiol. 2022; 65: 803-811Crossref PubMed Scopus (5) Google Scholar These measures accelerated during the COVID-19 pandemic, with implementation of ablation procedures at ambulatory surgical centers (ASCs) in the United States.3https://www.cms.gov/newsroom/press-releases/cms-announces-comprehensive-strategy-enhance-hospital-capacity-amid-covid-19-surgeGoogle Scholar, 4Thihalolipavan S. Lemery R. Swarup S. et al.Interventional Electrophysiology in the Ambulatory Surgical Center during SARS-COV-2 Pandemic.Heart Rhythm. 2022; 19: S423-S424Abstract Full Text Full Text PDF Google Scholar, 5Willcox M.E. Baker I. Sedwick 3rd, J. et al.Ablation of atrial fibrillation in an ambulatory outpatient setting.Heart Rhythm O2. 2023; 4: 478-482Abstract Full Text Full Text PDF Scopus (0) Google Scholar With cardiac rhythm device implantation procedures already being performed at ASCs, expanding ablation procedures to the ASC setting has garnered interest among US clinicians. To inform advocacy efforts, the HRS Health Policy and Regulatory Affairs Committee (HPRAC) conducted a survey to gauge current practice and opinions concerning SDD and ASCs. In May 2023, a survey was distributed via e-mail, social media, and signage at the HRS Scientific Sessions. All responses were completed digitally. Of 705 survey respondents, 661 (94%) were based in the US: 83% physicians (65% with >10 years experience), of whom 24% practice in academic settings, 40% were employed by non-academic hospitals, 30% in private practice. Among US Physicians, 18% of respondents were in the Northeast, 19% in the Midwest, 40% in the South, and 23% in the West. The full survey results are available at https://www.hrsonline.org/guidance/health-policy, with key responses summarized in Figure 1. Respondents are currently practicing SDD for many EP procedures: 88% for right (R)-side SVT/flutter ablations, 80-83% for pacemaker/ICD implants, 73-74% for AF/left (L)-side SVT/flutter ablations, and 78% for R-side PVC ablations. As expected, far fewer respondents allow SDD after VT ablation in cardiomyopathy (16-23%) or lead removal using extraction tools (8%). Some also commented on allowing SDD after LAAO procedures. Interestingly, for hospital-based procedures (not including ASCs), only 60% have cardiothoracic (CT) surgical backup available on-site for every ablation procedure, while 36% reported lack of such backup availability. For US respondents, 82% were aware that device implants are already covered by CMS in ASCs, with 73% aware of different facility fee schedules to hospitals and ASCs for these covered procedures; 16% have had or currently have ownership stake in an ASC, while 22% currently perform EP procedures in an ASC (81% privately owned vs 15% hospital-owned; 88% do not have on-site CT surgical back-up; 82% have a hospital transfer agreement in place; the majority of respondents do device implant cases only, with 10-30% doing various ablation cases). Respondents were asked which procedures could be safely performed in ASCs with proper resources and patient selection. Compared with 77-94% who believed various device implant cases could be safely done in ASCs, 77% believed so for R-side SVT/flutter, 45-46% believed so for AF and L-side SVT/flutter, 52% for R-side PVC, 33% for L-side PVC, and only 7-11% for VT ablation in cardiomyopathy. Conversely, 9% believed ICD implant and R-side SVT/flutter ablation should never be performed in an ASC, while 31% believed so for AF ablation, 65-75% for cardiomyopathy VT ablation, and 78% for any epicardial procedure. Responses were relatively consistent across US regions, by practice setting, and by experience levels. Additional comments were posted by nearly 200 respondents, with viewpoints emphasizing benefits of ASCs for patient access and cost, and others raising concerns for safety and quality. Overall, there was a strong sentiment for HRS to be an effective advocate for expanding EP services to ASCs while offering clear guidance regarding proper patient selection and safety mechanisms. With inherent limitations of a voluntary survey, the results herein provide a basis for ongoing dialogue as we advocate for expanding patient access to EP procedures while maintaining safety and managing costs. HRS remains dedicated to our mission "to improve the care of patients by promoting research, education, and optimal health care policies and standards". A joint task force has been formed with leadership from HRS and the American College of Cardiology (ACC) to examine, advocate, and advise on the implementation of EP services in ASCs. Within HRS, the HPRAC will remain engaged in our members' concerns and voice their needs - stay informed at https://www.hrsonline.org/guidance/advocacy-in-action.

Background The benefit of implantable cardioverter defibrillator (ICD) therapy in patients who have heart failure with improved left ventricular ejection fraction (LVEF) to >35% after implantation (HFimpEF) is controversial. Methods Databases (Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar) were queried for studies of ICD patients that reported the association between HFimpEF and arrhythmic events (AEs), defined as the combined incidence of ventricular arrhythmias, appropriate ICD intervention and sudden cardiac death (primary composite endpoint). Results A total of 41 studies and 38,572 patients (11,135 with HFimpEF, 27,437 with persistent EF <35%) were included; mean follow up was 43 months. HFimpEF was associated with decreased AEs (OR 0.39, 95% CI 0.32-0.47; annual rate (AR) 4.1% vs. 8%; P<0.01). Super-responders (EF >50%) had a lower risk of AEs than patients with more modest reverse remodeling (EF>35% and <50%, OR 0.25, 95% CI 0.14-0.46; AR 2.7% vs. 6.2%; P<0.01). HFimpEF patients who had an initial primary prevention indication had a lower risk of AEs (OR 0.43, 95% CI 0.3-0.61; AR 5.1% vs. 10.3%; P<0.01). Among primary prevention patients who had never received appropriate ICD therapy at the time of generator change, HFimpEF was associated with decreased subsequent AEs (OR 0.26, 95% CI 0.12-0.59; AR 1.6% vs. 4.8%; P<0.01). Conclusion HFimpEF is associated with reduced, but not eliminated, risk for AEs in patients with ICDs. The decision for replacing an ICD in lower risk subgroups should incorporate shared decision making based on risks for subsequent AEs and procedural complications.