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BACKGROUND: Black Americans have a higher risk of nonischemic cardiomyopathy (NICM) than White Americans. We aimed to evaluate differences in the risk of tachyarrhythmias among patients with an implantable cardioverter-defibrillator (ICD). METHODS: The study population comprised 3895 ICD recipients in the United States enrolled in primary prevention ICD trials. Outcome measures included ventricular tachyarrhythmia (VTA), atrial tachyarrhythmia (ATA), ICD therapies, VTA burden (using Andersen-Gill recurrent event analysis), death, and the predicted benefit of the ICD. All events were adjudicated blindly. Outcomes were compared between self-reported Black patients versus White patients with cardiomyopathy (ischemic and NICM). RESULTS: Black patients were more likely to be female (35% versus 22%) and younger (57±12 versus 62±12 years) with a higher frequency of comorbidities. In NICM, Black patients had a higher rate of first VTA, fast VTA, ATA, and appropriate and inappropriate ICD therapy (VTA ≥170 bpm, 32% versus 20%; VTA ≥200 bpm, 22% versus 14%; ATA, 25% versus 12%; appropriate therapy, 30% versus 20%; and inappropriate therapy, 25% versus 11%; P <0.001 for all). Multivariable analysis showed that Black patients with NICM experienced a higher risk of all types of arrhythmia or ICD therapy (VTA ≥170 bpm, hazard ratio [HR] 1.71; VTA ≥200 bpm, HR 1.58; ATA, HR 1.87; appropriate therapy, HR 1.62; inappropriate therapy, HR 1.86; P ≤0.01 for all), higher burden of tachyarrhythmias or therapies (VTA, HR 1.84; appropriate therapy, HR 1.84; P <0.001 for both), and a higher risk of death (HR 1.92; P =0.014). In contrast, in ischemic cardiomyopathy, the risk of all types of tachyarrhythmia, ICD therapy, or death was similar between Black patients and White patients. Both Black patients and White patients derived a significant and similar benefit from ICD implantation. CONCLUSIONS: Among patients with NICM with an ICD for primary prevention, Black patients compared with White patients had a high risk and burden of VTA, ATA, and ICD therapies with a lower survival rate. Nevertheless, the overall benefit of the ICD was maintained and was similar to that of White patients. [ABSTRACT FROM AUTHOR]

Keywords: antiarrhythmic drugs; arrhythmias; atrial fibrillation; supraventricular tachycardia; ventricular tachycardia EN antiarrhythmic drugs arrhythmias atrial fibrillation supraventricular tachycardia ventricular tachycardia 937 939 3 04/20/20 20200317 NES 200317 Antiarrhythmic drugs (AADs) are widely prescribed to treat both ventricular and supraventricular arrhythmias. Arrhythmia diagnoses were combined into meaningful categories including atrial fibrillation and flutter; ventricular tachycardia and fibrillation; and supraventricular tachycardia. Antiarrhythmic drugs, arrhythmias, atrial fibrillation, supraventricular tachycardia, supraventricular tachycardia, ventricular tachycardia. [Extracted from the article]

Background: Recognition of rates and causes of hard, patient-centered outcomes of death and cerebrovascular events (CVEs) after heart rhythm disorder management (HRDM) procedures is an essential step for the development of quality improvement programs in electrophysiology laboratories. Our primary aim was to assess and characterize death and CVEs (stroke or transient ischemic attack) after HRDM procedures over a 17-year period.Methods: We performed a retrospective cohort study of all patients undergoing HRDM procedures between January 2000 and November 2016 at the Mayo Clinic. Patients from all 3 tertiary academic centers (Rochester, Phoenix, and Jacksonville) were included in the study. All in-hospital deaths and CVEs after HRDM procedures were identified and were further characterized as directly or indirectly related to the HRDM procedure. Subgroup analysis of death and CVE rates was performed for ablation, device implantation, electrophysiology study, lead extraction, and defibrillation threshold testing procedures.Results: A total of 48 913 patients (age, 65.7±6.6 years; 64% male) who underwent a total of 62 065 HRDM procedures were included in the study. The overall mortality and CVE rates in the cohort were 0.36% (95% confidence interval [CI], 0.31-0.42) and 0.12% (95% CI, 0.09-0.16), respectively. Patients undergoing lead extraction had the highest overall mortality rate at 1.9% (95% CI, 1.34-2.61) and CVE rate at 0.62% (95% CI, 0.32-1.07). Among patients undergoing HRDM procedures, 48% of deaths directly related to the HDRM procedure were among patients undergoing device implantation procedures. Overall, cardiac tamponade was the most frequent direct cause of death (40%), and infection was the most common indirect cause of death (29%). The overall 30-day mortality rate was 0.76%, with the highest being in lead extraction procedures (3.08%), followed by device implantation procedures (0.94%).Conclusions: Half of the deaths directly related to an HRDM procedure were among the patients undergoing device implantation procedures, with cardiac tamponade being the most common cause of death. This highlights the importance of the development of protocols for the quick identification and management of cardiac tamponade even in procedures typically believed to be lower risk such as device implantation. [ABSTRACT FROM AUTHOR]

Background: Data are lacking on national trends for atrial fibrillation (AF) hospitalization, particularly with regard to long-term outcomes including readmission and mortality.Methods: We studied all Medicare fee-for-service beneficiaries between 1999 and 2013, and we evaluated rates of hospitalization for AF, in-hospital mortality, length of stay, and hospital payments. We then evaluated rates of long-term outcomes, including 30-day readmission, 30-day mortality, and 1-year mortality. To evaluate changes in rates of AF hospitalization and mortality, we used mixed-effects models, adjusting for age, sex, race, and comorbidity. To assess changes in rates of 30-day readmission, we constructed a Cox proportional hazards model adjusting for age, sex, race, and comorbidity.Results: Adjusted rates of hospitalization for AF increased by ≈1% per year between 1999 and 2013, and although geographic variation was present, this trend was consistent nationwide. Median hospital length of stay remained unchanged at 3.0 (interquartile range 2.0-5.0) days, but median Medicare inpatient expenditure per beneficiary increased from $2932 (interquartile range $2232-$3870) to $4719 (interquartile range $3124-$7209) per stay. During the same period, the rate of inpatient mortality during AF hospitalization decreased by 4% per year, and the rate of 30-day readmission decreased by 1% per year. The rates of 30-day and 1-year mortality decreased more modestly by 0.4% and 0.26% per year, respectively.Conclusions: Between 1999 and 2013, among Medicare fee-for-service beneficiaries, patients were hospitalized more frequently and treated with more costly inpatient therapies such as AF catheter ablation, but this finding was associated with improved outcomes, including lower rates of in-hospital mortality, 30-day readmission, 30-day mortality, and 1-year mortality. [ABSTRACT FROM AUTHOR]

The article discusses the valvular condition of mitral valve prolapse (MVP) in patients who have experienced sudden cardiac death. Topics discussed include the scope of the medical study conducted on patients with MVP, the common phenotype observed in the patient sample, and the conclusions of the study.

The article projects the future of cardiovascular (CV) biomedicine in terms of cardiac arrhythmias and electrophysiology in the U.S. Topics discussed include an overview of cardiac arrhythmias, its diagnostic strategies, its lead technology and implantable devices, its ablation strategies, its pharmacological and genomic therapies, and its trends.

Background: Asymptomatic individuals account for the majority of sudden cardiac deaths (SCDs). Development of effective, low-cost, and noninvasive SCD risk stratification tools is necessary.Methods and Results: Participants from the Atherosclerosis Risk in Communities study and Cardiovascular Health Study (n=20 177; age, 59.3±10.1 years; age range, 44-100 years; 56% female; 77% white) were followed up for 14.0 years (median). Five ECG markers of global electric heterogeneity (GEH; sum absolute QRST integral, spatial QRST angle, spatial ventricular gradient [SVG] magnitude, SVG elevation, and SVG azimuth) were measured on standard 12-lead ECGs. Cox proportional hazards and competing risks models evaluated associations between GEH electrocardiographic parameters and SCD. An SCD competing risks score was derived from demographics, comorbidities, and GEH parameters. SCD incidence was 1.86 per 1000 person-years. After multivariable adjustment, baseline GEH parameters and large increases in GEH parameters over time were independently associated with SCD. Final SCD risk scores included age, sex, race, diabetes mellitus, hypertension, coronary heart disease, stroke, and GEH parameters as continuous variables. When GEH parameters were added to clinical/demographic factors, the C statistic increased from 0.777 to 0.790 (P=0.008), the risk score classified 10-year SCD risk as high (>5%) in 7.2% of participants, 10% of SCD victims were appropriately reclassified into a high-risk category, and only 1.4% of SCD victims were inappropriately reclassified from high to intermediate risk. The net reclassification index was 18.3%.Conclusions: Abnormal electrophysiological substrate quantified by GEH parameters is independently associated with SCD in the general population. The addition of GEH parameters to clinical characteristics improves SCD risk prediction. [ABSTRACT FROM AUTHOR]

Objective: To review the literature systematically to determine whether noninvasive or invasive risk stratification, such as with an electrophysiological study of patients with asymptomatic pre-excitation, reduces the risk of arrhythmic events and improves patient outcomes.Methods: PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (all January 1, 1970, through August 31, 2014) were searched for randomized controlled trials and cohort studies examining noninvasive or invasive risk stratification in patients with asymptomatic pre-excitation. Studies were rejected for low-quality design or the lack of an outcome, population, intervention, or comparator of interest or if they were written in a language other than English.Results: Of 778 citations found, 9 studies met all the eligibility criteria and were included in this paper. Of the 9 studies, 1 had a dual design-a randomized controlled trial of ablation versus no ablation in 76 patients and an uncontrolled prospective cohort of 148 additional patients-and 8 were uncontrolled prospective cohort studies (n=1594). In studies reporting a mean age, the range was 32 to 50 years, and in studies reporting a median age, the range was 19 to 36 years. The majority of patients were male (range, 50% to 74%), and <10% had structural heart disease. In the randomized controlled trial component of the dual-design study, the 5-year Kaplan-Meier estimates of the incidence of arrhythmic events were 7% among patients who underwent ablation and 77% among patients who did not undergo ablation (relative risk reduction: 0.08; 95% confidence interval: 0.02 to 0.33; P<0.001). In the observational cohorts of asymptomatic patients who did not undergo catheter ablation (n=883, with follow-up ranging from 8 to 96 months), regular supraventricular tachycardia or benign atrial fibrillation (shortest RR interval >250 ms) developed in 0% to 16%, malignant atrial fibrillation (shortest RR interval ≤250 ms) in 0% to 9%, and ventricular fibrillation in 0% to 2%, most of whom were children in the last case.Conclusions: The existing evidence suggests risk stratification with an electrophysiological study of patients with asymptomatic pre-excitation may be beneficial, along with consideration of accessory-pathway ablation in those deemed to be at high risk of future arrhythmias. Given the limitations of the existing data, well-designed and well-conducted studies are needed. [ABSTRACT FROM AUTHOR]

Several well-designed and conducted randomized clinical trials (RCTs) have proven the survival benefit of implantable cardioverter defibrillators (ICDs). This benefit has been demonstrated in patients who survive a cardiac arrest due to a ventricular tachyarrhythmia or have sustained ventricular tachycardia not due to a transient or a reversible cause. The survival benefit of ICDs has also been shown in patients with significant systolic dysfunction (left ventricular ejection fraction (LVEF) ≤35%) due to ischemic or non-ischemic cardiomyopathy. The compelling evidence on the benefits of ICDs led the Centers for Medicare and Medicaid services (CMS) to cover secondary and primary prevention ICDs in Medicare beneficiaries. However, for primary prevention ICDs, CMS provides coverage with evidence development that requires clinicians to enter data on primary prevention ICD implants in Medicare beneficiaries into the National Cardiovascular Data Registry (NCDR) ICD Registry. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the frequency of arrhythmia in pregnancy over time. Analysis of data of pregnancy-related hospitalizations by arrhythmia, supraventricular tachycardia (SVT), and atrial fibrillation (AF) and ventricular arrhythmias from 2000 to 2012 is offered. Results highlight an increase in the frequency of arrhythmia in which the most frequent is AF.

The article presents study on the stratification of risk due to ventricular tachyarrhythmias in patients with left ventricular dysfunction in the U.S. The occurrence of fatal ventricular tachyarrhythmias cannot be accessed accurately. The rate of sudden cardiac death has decreased by 49 percent in the U.S. The SCD mechanism involves the development of ventricular tachycardia which generates into ventricular fibrillation and lead to death.

The article presents information on a ventricular tachycardia Torsade de Pointes (TdP). It mentions about the cyclic shifting of the QRS axis, a heart axis, after the prolongation of QT interval which is the main reason for this quintessential arrhythmia. In the U.S., more than 35 normal people die due to sudden cardiac death (SCD). It further informs about genome wide association studies (GWAS) and common models for myocardial infarction like zebrafish.

Background--Community-acquired pneumonia (CAP) affects >5 million adults each year in the United States. Although incident cardiac complications occur in patients with community-acquired pneumonia, their incidence, timing, risk factors, and associations with short-term mortality are not well understood. Methods and Results--A total of 1343 inpatients and 944 outpatients with community-acquired pneumonia were followed up prospectively for 30 days after presentation. Incident cardiac complications (new or worsening heart failure, new or worsening arrhythmias, or myocardial infarction) were diagnosed in 358 inpatients (26.7%) and 20 outpatients (2.1%). Although most events (89.1% in inpatients, 75% in outpatients) were diagnosed within the first week, more than half of them were recognized in the first 24 hours. Factors associated with their diagnosis included older age (odds ratio [OR] =1.03; 95% confidence interval [CI], 1.02-1.04), nursing home residence (OR, 1.8; 95% CI. 1.2-2.9), history of heart failure (OR, 4.3; 95% CI, 3.0-6.3), prior cardiac arrhythmias (OR, 1.8; 95% CI, 1.2-2.7), previously diagnosed coronary artery disease (OR, 1.5; 95% CI, 1.04-2.0), arterial hypertension (OR, 1.5; 95% CI, 1.1-2.1), respiratory rate >30 breaths per minute (OR, 1.6; 95% CI, 1.1-2.3), blood pH <7.35 (OR, 3.2; 95% CI, 1.8-5.7), blood urea nitrogen >30 mg/dL (OR, 1.5; 95% CI, 1.1-2.2), serum sodium <130 mmol/L (OR, 1.8; 95% CI, 1.02-3.1), hematocrit <30% (OR, 2.0; 95% CI, 1.3-3.2), pleural effusion on presenting chest x-ray (OR, 1.6; 95% CI, 1.1-2.4), and inpatient care (OR, 4.8; 95% CI, 2.8-8.3). Incident cardiac complications were associated with increased risk of death at 30 days after adjustment for baseline Pneumonia Severity Index score (OR, 1.6; 95% CI, 1.04-2.5). Conclusions--Incident cardiac complications are common in patients with community-acquired pneumonia and are associated with increased short-term mortality. Older age, nursing home residence, preexisting cardiovascular disease, and pneumonia severity are associated with their occurrence. Further studies are required to test risk stratification and prevention and treatment strategies for cardiac complications in this population. [ABSTRACT FROM AUTHOR]

Background-Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting >2 million patients in the United States alone. Despite decades of research, surprisingly little is known regarding the molecular pathways underlying the pathogenesis of AF. ANK2+ encodes ankyrin-B, a multifunctional adapter molecule implicated in membrane targeting of ion channels, transporters, and signaling molecules in excitable cells. Methods and Results-In the present study, we report early-onset AF in patients harboring loss-of-function mutations in ANK2+. In mice, we show that ankyrin-B deficiency results in atrial electrophysiological dysfunction and increased susceptibility to AF. Moreover, ankyrin-B+/- atrial myocytes display shortened action potentials, consistent with human AF. Ankyrin-B is expressed in atrial myocytes, and we demonstrate its requirement for the membrane targeting and function of a subgroup of voltage-gated Ca2+ channels (Cav 1.3) responsible for low voltage-activated L-type Ca2+ current. Ankyrin-B is associated directly with Cav 1.3, and this interaction is regulated by a short, highly conserved motif specific to Ca2+ 1.3. Moreover, loss of ankyrin-B in atrial myocytes results in decreased Cav 1.3 expression, membrane localization, and function sufficient to produce shortened atrial action potentials and arrhythmias. Finally, we demonstrate reduced ankyrin-B expression in atrial samples of patients with documented AF, further supporting an association between ankyrin-B and AF. Conclusions-These findings support that reduced ankyrin-B expression or mutations in ANK2 are associated with AF. Additionally, our data demonstrate a novel pathway for ankyrin-Bdependent regulation of Cav 1.3 channel membrane targeting and regulation in atrial myocytes. [ABSTRACT FROM AUTHOR]

Background-Early repolarization (ER) in inferior/lateral leads of standard ECGs increases the risk of arrhythmic death. We tested the hypothesis that variations in the ST-segment characteristics after the ER waveforms may have prognostic importance. Methods and Results-ST segments after ER were classified as horizontal/descending or rapidly ascending/upsioping on the basis of observations from 2 independent samples of young healthy athletes from Finland (n = 62) and the United States (n503), where ascending type was the dominant and common form of ER. Early repolarization was present in 27/62 (44%) of the Finnish athletes and 151/503 (30%) of the US athletes, and all but! of the Finnish (96%) and 91/107 (85%) of US athletes had an ascending/upsloping ST variant after ER. Subsequently, ECGs from a general population of 10 864 middle-aged subjects were analyzed to assess the prognostic modulation of ER-associated risk by ST-segment variations. Subjects with ER≥0.1 mV and horizontal/descending ST variant (n=412) had an increased hazard ratio of arrhythmic death (relative risk 1.43; 95% confidence interval 1.05 to 1.94). When modeled for higher amplitude ER (>0.2 mV) in inferior leads and horizontal/descending ST-segment variant, the hazard ratio of arrhythmic death increased to 3.14 (95% confidence interval 1.56 to 6.30). However, in subjects with ascending ST variant, the relative risk for arrhythmic death was not increased (0.89; 95% confidence interval 0.52 to 1.55). Conclusions-ST-segment morphology variants associated with ER separates subjects with and without an increased risk of arrhythmic death in middle-aged subjects. Rapidly ascending ST segments after the J-point, the dominant ST pattern in healthy athletes, seems to be a benign variant of ER. [ABSTRACT FROM AUTHOR]

The author reflects on the importance of electrocardiography (ECG) in protecting and guiding the young athletes from sudden cardiac death in the U.S. He describes the importance of making a distinction between physiological and pathological changes during the process of athletic cardiac remodeling which vary from sex, age, race, level of fitness, and type of sport. He also notes that ECG could be performed repeatedly when palpitations, dizziness or unexpected changes in performance occur.

Background: Yearly trends and prevalence of alcoholic cardiomyopathy (ACMP) hospitalizations and its associated in-hospital mortality, arrhythmia, complications and outcomes are not well studied on a national level. Methods: We used Nationwide Inpatient Sample database (2005-14) and identified 25402 hospitalizations for adults (≥18 yrs) with a primary or secondary diagnosis of ACMP. Since ACMP is a diagnosis of exclusion, all patients with a co-diagnosis of CAD or other causes of cardiomyopathy were excluded. Results: Taking the growth of the US general population into account, there was a decreasing number of ACMP hospital stays per 100,000 persons (4.38 in 2005 vs 3.62 in 2014; p < 0.001). Arrhythmias were present in in 48.7% of hospital stays. In-hospital mortality was 4.2% down-trending over years (4.3% 2005 vs 3.7% 2014) but this was not statistically significant (p = 0.78). Approximately 2.1% experienced cardiac arrest(uptrend from 1.4% to 3.2% in 2005-14; p <0.001). Prevalence of arrhythmia in this population has increased from 2005 to 2014 (46.5% vs 51.6%; p <0.001). Mean age was 55.01 ±12.2 yrs and 85.2% were male. Patients with arrhythmia were older (57.08 vs 53.03; p<0.01), had more comorbidities (Elixhauser index 2.55 vs 1.85; p <.01). Gender and racial differences were noted between arrhythmia and non-arrhythmia group respectively: Male (88.6% vs 82%; p< 0.01),White (68.2% vs 57.4%), Black (18.8% vs 28.5%) (p < 0.01). AFib was the most common type of arrhythmia (30.7%), followed by V Tach (8.7%), unspecified arrhythmia (8.6%), and AFlutter (5.6%). Median charge per hospital stay was $25909. Median length of stay was 4 d. Despite that the Median length of stay (4 days) has not changed (4 days in 2005 vs 5 days in 2014; p = 16%), Median charge per hospital stay has increased from $18223.5 to $34056 : p <0.01. Cardioversion was performed in 1.2 %, Catheter ablation in 0.4 %, PPM implantation in 0.7 %, ICD in 1.5 %, cardiac catheterization in 16 % and VAD in 0.1% of hospitalizations for alcoholic cardiomyopathy. Utilization of these procedures has increased from 12% in 2005 to 14.6% in 2014 (p = 2.6%) Conclusion: There was a decreasing number of ACMP hospitalizations per 100,000 of US population. Despite the increased prevalence of arrhythmias in this population over years, the in-hospital mortality has not change, but rate of cardiac arrest has increased. The Median length of hospital stay has not changed, but the healthcare cost has significantly increased. This could be explained by the increased utilization of inpatient cardiac procedures. [ABSTRACT FROM AUTHOR]

Introduction: Mortality caused by ventricular arrhythmias (VA) remains a problem of epidemic proportions. Its understanding could help us improve the allocation of healthcare resources and risk prediction. Hypothesis: To understand current trends on admissions of VA, patient characteristic, morbidity, mortality, and healthcare utilization. Methods: Administrative dataset(Nationwide Inpatient Sample-NIS) from 2010-2015 identified 290998 VA hospitalization using ICD 9 code 427.1 in primary field, which were grouped in Group 1: Normal Heart; Group 2: ischemic heart disease (IHD), Group 3: non-ischemic heart disease (non-IHD); Group 4: ICD shocks; Group 5: sudden cardiac death (SCD - cardiac arrest without ICD shock) using appropriate ICD-9 codes. Survey design and models were used for analysis.A cochrane-armitage test was used to generate p-value for trends of categorical variables. Results: The overall number of admissions for VA decreased during study period but the proportion of SCD and ICD shock amongst VA hospitalization was increased. In hospital mortality increased over study period which was driven by in hospital mortality in SCD and ICD shock patients. Utilizations of VT ablation decreased, driven by VT ablation in normal heart. There was trend towards decreased ICD implantation. In multivariate analysis, SCD (OR: 14.05, 95% CI: 11.00 - 17.94, p<0.001) was the strongest predictor of in hospital mortality, followed by patients with non-IHD (OR:1.54, 95% CI: 1.16-2.04, p-0.003), patients with ICD shocks (OR:1.44, 95% CI: 1.12-1.85, p-0.005). Other variables associated with worsening mortality were older age, female gender, peripheral vascular disease, chronic kidney disease, previous stroke, coagulopathy, weekend admissions. Similiar variables were responsible for prolonging length of stay. while elective admission and higher household incomes were associated with improved mortality. Conclusions: We report a decrease in admissions for VA, decrease in ICD utilization, a change in the pattern of VT ablation utilization, and an increase of in-hospital mortality. Predictors of adverse outcomes identified in our study should be considered when developing risk models for patients undergoing risk-assessment of SCD. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is available in the text. [ABSTRACT FROM AUTHOR]

Background and Purpose: This scientific statement provides an interprofessional, comprehensive review of evidence and recommendations for indications, duration, and implementation of continuous electro cardiographic monitoring of hospitalized patients. Since the original practice standards were published in 2004, new issues have emerged that need to be addressed: overuse of arrhythmia monitoring among a variety of patient populations, appropriate use of ischemia and QT-interval monitoring among select populations, alarm management, and documentation in electronic health records.Methods: Authors were commissioned by the American Heart Association and included experts from general cardiology, electrophysiology (adult and pediatric), and interventional cardiology, as well as a hospitalist and experts in alarm management. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Authors were assigned topics relevant to their areas of expertise, reviewed the literature with an emphasis on publications since the prior practice standards, and drafted recommendations on indications and duration for electrocardiographic monitoring in accordance with the American Heart Association Level of Evidence grading algorithm that was in place at the time of commissioning.Results: The comprehensive document is grouped into 5 sections: (1) Overview of Arrhythmia, Ischemia, and QTc Monitoring; (2) Recommendations for Indication and Duration of Electrocardiographic Monitoring presented by patient population; (3) Organizational Aspects: Alarm Management, Education of Staff, and Documentation; (4) Implementation of Practice Standards; and (5) Call for Research.Conclusions: Many of the recommendations are based on limited data, so authors conclude with specific questions for further research. [ABSTRACT FROM AUTHOR]

The article offers information on atrial fibrillation, regarded as the most common arrythmia, affecting around three million adults in the U.S.