Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology.

WRITING GROUP MEMBERS Emelia J. Benjamin, MD, SCM, FAHA Michael J. Blaha, MD, MPH Stephanie E. Chiuve, ScD Mary Cushman, MD, MSc, FAHA Sandeep R. Das, MD, MPH, FAHA Rajat Deo, MD, MTR Sarah D. de Ferranti, MD, MPH James Floyd, MD, MS Myriam Fornage, PhD, FAHA Cathleen Gillespie, MS Carmen R. Isasi, MD, PhD, FAHA Monik C. Jiménez, ScD, SM Lori Chaffin Jordan, MD, PhD Suzanne E. Judd, PhD Daniel Lackland, DrPH, FAHA Judith H. Lichtman, PhD, MPH, FAHA Lynda Lisabeth, PhD, MPH, FAHA Simin Liu, MD, ScD, FAHA Chris T. Longenecker, MD Rachel H. Mackey, PhD, MPH, FAHA Kunihiro Matsushita, MD, PhD, FAHA Dariush Mozaffarian, MD, DrPH, FAHA Michael E. Mussolino, PhD, FAHA Khurram Nasir, MD, MPH, FAHA Robert W. Neumar, MD, PhD, FAHA Latha Palaniappan, MD, MS, FAHA Dilip K. Pandey, MBBS, MS, PhD, FAHA Ravi R. Thiagarajan, MD, MPH Mathew J. Reeves, PhD Matthew Ritchey, PT, DPT, OCS, MPH Carlos J. Rodriguez, MD, MPH, FAHA Gregory A. Roth, MD, MPH Wayne D. Rosamond, PhD, FAHA Comilla Sasson, MD, PhD, FAHA Amytis Towfighi, MD Connie W. Tsao, MD, MPH Melanie B. Turner, MPH Salim S. Virani, MD, PhD, FAHA Jenifer H. Voeks, PhD Joshua Z. Willey, MD, MS John T. Wilkins, MD Jason HY. Wu, MSc, PhD, FAHA Heather M. Alger, PhD Sally S. Wong, PhD, RD, CDN, FAHA Paul Muntner, PhD, MHSc On behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Heart Disease and Stroke Statistics—2017 Update

Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association

Author(s): Writing Group Members; Mozaffarian, Dariush; Benjamin, Emelia J; Go, Alan S; Arnett, Donna K; Blaha, Michael J; Cushman, Mary; Das, Sandeep R; de Ferranti, Sarah; Despres, Jean-Pierre; Fullerton, Heather J; Howard, Virginia J; Huffman, Mark D; Isasi, Carmen R; Jimenez, Monik C; Judd, Suzanne E; Kissela, Brett M; Lichtman, Judith H; Lisabeth, Lynda D; Liu, Simin; Mackey, Rachel H; Magid, David J; McGuire, Darren K; Mohler, Emile R; Moy, Claudia S; Muntner, Paul; Mussolino, Michael E; Nasir, Khurram; Neumar, Robert W; Nichol, Graham; Palaniappan, Latha; Pandey, Dilip K; Reeves, Mathew J; Rodriguez, Carlos J; Rosamond, Wayne; Sorlie, Paul D; Stein, Joel; Towfighi, Amytis; Turan, Tanya N; Virani, Salim S; Woo, Daniel; Yeh, Robert W; Turner, Melanie B; American Heart Association Statistics Committee; Stroke Statistics Subcommittee

Heart Disease and Stroke Statistics—2016 Update: A Report From the American Heart Association

March 5, 2019 e1 WRITING GROUP MEMBERS Emelia J. Benjamin, MD, ScM, FAHA, Chair Paul Muntner, PhD, MHS, FAHA, Vice Chair Alvaro Alonso, MD, PhD, FAHA Marcio S. Bittencourt, MD, PhD, MPH Clifton W. Callaway, MD, FAHA April P. Carson, PhD, MSPH, FAHA Alanna M. Chamberlain, PhD Alexander R. Chang, MD, MS Susan Cheng, MD, MMSc, MPH, FAHA Sandeep R. Das, MD, MPH, MBA, FAHA Francesca N. Delling, MD, MPH Luc Djousse, MD, ScD, MPH Mitchell S.V. Elkind, MD, MS, FAHA Jane F. Ferguson, PhD, FAHA Myriam Fornage, PhD, FAHA Lori Chaffin Jordan, MD, PhD, FAHA Sadiya S. Khan, MD, MSc Brett M. Kissela, MD, MS Kristen L. Knutson, PhD Tak W. Kwan, MD, FAHA Daniel T. Lackland, DrPH, FAHA Tené T. Lewis, PhD Judith H. Lichtman, PhD, MPH, FAHA Chris T. Longenecker, MD Matthew Shane Loop, PhD Pamela L. Lutsey, PhD, MPH, FAHA Seth S. Martin, MD, MHS, FAHA Kunihiro Matsushita, MD, PhD, FAHA Andrew E. Moran, MD, MPH, FAHA Michael E. Mussolino, PhD, FAHA Martin O’Flaherty, MD, MSc, PhD Ambarish Pandey, MD, MSCS Amanda M. Perak, MD, MS Wayne D. Rosamond, PhD, MS, FAHA Gregory A. Roth, MD, MPH, FAHA Uchechukwu K.A. Sampson, MD, MBA, MPH, FAHA Gary M. Satou, MD, FAHA Emily B. Schroeder, MD, PhD, FAHA Svati H. Shah, MD, MHS, FAHA Nicole L. Spartano, PhD Andrew Stokes, PhD David L. Tirschwell, MD, MS, MSc, FAHA Connie W. Tsao, MD, MPH, Vice Chair Elect Mintu P. Turakhia, MD, MAS, FAHA Lisa B. VanWagner, MD, MSc, FAST John T. Wilkins, MD, MS, FAHA Sally S. Wong, PhD, RD, CDN, FAHA Salim S. Virani, MD, PhD, FAHA, Chair Elect On behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee

Heart Disease and Stroke Statistics—2019 Update: A Report From the American Heart Association

Author(s): Go, Alan S; Mozaffarian, Dariush; Roger, Veronique L; Benjamin, Emelia J; Berry, Jarett D; Borden, William B; Bravata, Dawn M; Dai, Shifan; Ford, Earl S; Fox, Caroline S; Franco, Sheila; Fullerton, Heather J; Gillespie, Cathleen; Hailpern, Susan M; Heit, John A; Howard, Virginia J; Huffman, Mark D; Kissela, Brett M; Kittner, Steven J; Lackland, Daniel T; Lichtman, Judith H; Lisabeth, Lynda D; Magid, David; Marcus, Gregory M; Marelli, Ariane; Matchar, David B; McGuire, Darren K; Mohler, Emile R; Moy, Claudia S; Mussolino, Michael E; Nichol, Graham; Paynter, Nina P; Schreiner, Pamela J; Sorlie, Paul D; Stein, Joel; Turan, Tanya N; Virani, Salim S; Wong, Nathan D; Woo, Daniel; Turner, Melanie B; American Heart Association Statistics Committee and Stroke Statistics Subcommittee

Heart Disease and Stroke Statistics—2013 Update A Report From the American Heart Association

Cardiac Rhythm Management (CRM) appeared to have entered a golden age with the advent of implantable rhythm management devices. By 2005 financial analysts had proclaimed that this aspect of CRM had hit a threshold of a $5 billion industry. In a recent column, this commentator had noted that the extraordinary growth of this application had also sparked serious new Federal surveillance for benefits and risks [1]. In doing so, I observed that “they are enshrining the axiom that reimbursement will follow excellence in performance.” In the same period, considerable attention shifted to interventions in atrial fibrillation. The NHLBI-Heart Rhythm Society roundtable expert consensus statement in 2001 recognized the public health epidemic of atrial fibrillation required new and innovative research directions [2]. Analysing the central clinical research issues in this field, it recognized the potential role of therapeutic catheter interventions for rhythm control in this area. In fact, recent surveys have noted a gradual progression in atrial fibrillation ablation procedures but limitations in efficacy and the demanding nature of these procedures have also been well recognized [3, 4]. Finally, in allied but seemingly unrelated development, this column noted in 2001 that imaging techniques had “invaded the electrophysiologic laboratory at a fast and furious pace [5].” In this comment, we called for the many stakeholders in this field to seek “ guidelines for imaging standards, demonstration of efficacy and safety of the technology and imaging standards for comparison and definition of benefits in clinical practice.” In an expected but largely unheralded nexus of events since that time, interventional procedures are increasingly incorporating imaging modalities to further more effective and safer therapy delivery. This initiative is now evolving into a major and imminent advance in CRM. In doing so, they are addressing the need for excellence in performance. Complex data management, real time imaging for navigation & guidance and rapid and safe delivery of interventions are considered the keys to its success. With this development, rapid diagnosis and therapy delivery becomes ever more feasible. In an extension of this effort, physiologic monitoring of the impact of therapies is now being examined. Yet mating the optimal imaging technology to the interventional procedure and its goals has been challenging. One of the foremost considerations is to have real time online imaging and navigation. In this comment, a few examples will illustrate the variety of opportunities now opening their doors to the interventional electrophysiologist and their challenges. Real time anatomic guidance in interventional procedures in the catheterization laboratory has been developed by Sra and colleagues in fusing cardiac CT images with conventional fluoroscopic methods [6]. In this approach, a three dimensional cardiac chamber image is superimposed on the two dimensional fluoroscopic image using a registration process that aligns key anatomic landmarks in the two images [7]. This registered image can then be used to provide a framework for navigation of an ablation electrode, construct linear lesions or isolate specific anatomic structures. (Fig. 1) This approach uses a preexisting three-dimensional anatomic image of the patient with the real time two dimensional fluoroscopic image to permit online navigation. The obvious challenge of aligning these differing images is a very real one and has taken a substantial investigative commitment. Innovations in catheter electrode navigation have now been clinically tested in pilot reports. Magnetic navigation using a remote catheter ablation monitoring system can now permit three dimensional precision for in tackling the ablation target. An increasing number of reports attest to the increasing ability to precisely locate and treat arrhythmogenic

Real time online imaging for interventional electrophysiologists: many directions and extraordinary opportunities.

Laser ablation was performed intraoperatively in a patient with coronary artery disease and Wolff-Parkinson-White syndrome. Histopathological evaluation of the laser ablation site revealed a transverse laser incision in the left atrial septum and mitral valve annulus. There was hemorrhage in the atrioventricular (AV) groove with interruption of a posterolateral AV connection. The laser lesion was confined largely to the atrial aspect of the AV annulus. We conclude that laser catheter ablation of accessory pathways is feasible in humans.

Histopathological Changes Following Laser Ablation of a Left‐Sided Accessory Pathway in a Human

Acc/aha guidelines for implantation of cardiac pacemakers and anti arrhythmia devices : executive summary

Three-dimensional noncontact mapping demonstrates synergistic electrophysiologic effects of multisite atrial pacing and linear atrial ablation in patients with refractory atrial fibrillation

Reformation of the health care system in the United States is not a new event. Prior to the current passion for health care reform among politicians and officials in the nation's capital, most regions of the country have already witnessed impressive market-driven changes in health care delivery. For several years now, patients and medical practitioners have encountered attempts at improving efficiency and reducing cost. In certain cases substantial benefit has accrued. For example, increased emphasis on outpatient treatment has generally been highly successful. On the other hand, capricious denial of services by third party payors, all too ofren including regional representatives of the Federal government's own Medicare system, has brought needless suffering to many individuals and wrought havoc in many physicians' offices. The recent controversy regarding decisions related to bone marrow transplant procedures provide an important and timely example. Arriving at a realistic assessment of the current state of the health care system is extremely complex. It certainly includes the cost of providing optimal health care for those who need it. However, more than dollars, survival statistics need be accounted for. Ours is a service profession that thrives on addressing and hopefully diminishing disease promptly, and returning individuals to as normal a life as possible. Consequently, apart from simply providing \"access\" to a health care delivery system, the long-term needs of our patients ne-

Sanjeev Saksena

Papers

Real time online imaging for interventional electrophysiologists: many directions and extraordinary opportunities.

Histopathological Changes Following Laser Ablation of a Left‐Sided Accessory Pathway in a Human

Acc/aha guidelines for implantation of cardiac pacemakers and anti arrhythmia devices : executive summary

Three-dimensional noncontact mapping demonstrates synergistic electrophysiologic effects of multisite atrial pacing and linear atrial ablation in patients with refractory atrial fibrillation

The "reform" juggernaut: considerations for participants in the health care debate.