Dr. Arthur J. Moss served as Editor‐in‐Chief of the Annals of Noninvasive Electrocardiology since 1996 until 2011. Together with Dr. Shlomo Stern (who served as Co‐Editor‐in‐Chief) they established the journal of the International Society for Holter and Noninvasive Electrocardioloy (ISHNE). The Annals has been making significant contributions to the field of electrocardiology for over 20 years. Since 2012, I have a pleasure and honor to continue this mission. In 2013 we lost Dr. Shlomo Stern and on February 14, 2018, we lost Dr. Arthur J. Moss at the age of 86 years.
Dr. Moss was born on June 21, 1931. He graduated with psychology degree from the Yale University in 1953, and Harvard Medical School in 1957, and after his military service in the US Navy he joined the University of Rochester Medical School in 1961. His entire clinical and research career was devoted to fighting heart disease, helping patients and developing better treatments. In 1962, Dr. Moss published a paper in the New England Journal of Medicine (NEJM) on the closed‐chest cardiac massage in the treatment of ventricular fibrillation in three acute myocardial infarction patients successful resuscitated (Moss et al., 1962). Over the next 30 years Dr. Moss conducted several studied and published numerous papers focused on the risk stratification of patients after myocardial infarction. The Multicenter Postinfarction Program (MPIP) was a multicenter study that established: (1) importance of low ejection fraction in predicting mortality (Moss, Bigger, & Odoroff, 1987), (2) prognostic significance of frequent ventricular premature beats and nonsustained ventricular tachycardia (Bigger, Fleiss, & Rolnitzky, 1986), and (3) prognostic significance of heart rate variability (Kleiger, Miller, Bigger, & Moss, 1987). These publications set the stage for common use of Holter monitoring to document ventricular arrhythmias and led to subsequent development of the entire field of heart rate variability research.
In 1970‐iest Dr. Michel Mirowski and his team developed implantable cardioverter‐defibrillator (ICD) and Dr. Moss was very attracted to this concept. Based on his prior work on the risk stratification that showed low ejection fraction and nonsustained ventricular tachycardia as predictors of mortality and sudden cardiac death he designed the Multicenter Automatic Defibrillator Implantation Trial (MADIT) in which ICD reduced mortality by over 50% (Moss et al., 1996). Subsequent MADIT II trial (Moss et al., 2002) with a 30% reduction of mortality had even bigger impact on medicine and cardiology with widespread use of ICDs for primary prevention of mortality. Heart failure related morbidity and mortality observed in MADIT II trial patients could not be reduced by an ICD and therefore, the next trial tested ICD with cardiac resynchronization therapy, MADIT‐CRT trial conducted in NYHA class I and II patients with ejection fraction ≤30% (Moss et al., 2009). A 30% reduction in the primary endpoint of heart failure events or death was observed with even more pronounced benefit in patients with left bundle branch block (Zareba et al., 2011). The MADIT RIT (Reducing Inappropriate Therapy) followed with evidence for beneficial role of innovative ICD programming at higher rate and delayed device therapy (Moss et al., 2012). The MADIT‐SICD which recently has started was the last trial designed by Dr. Moss to address the challenge of an increased mortality in post‐infarction patients with diabetes and ejection fraction of 36%–50% by implanting subcutaneous ICDs (Kutyifa et al., 2017).
In 1971 (Moss & McDonald, 1971), Dr. Moss described new method of treatment of long QT syndrome (LQTS) patients: left cervivco‐thoracic ganglionectomy (surgical procedure to diminish risk of cardiac arrhythmias) and this experience with LQTS patients led him toward establishing in 1979 the International LQTS Registry (Moss et al. 1991). This registry resulted in very significant advancements in the field of the LQTS and cardiac arrhythmias (Moss et al. 2003). Dr. Moss was eminently successful in getting funding from the National Institute of Health (NIH) for the registry for the last 40 years and this research led to major breakthroughs in understanding genetic causes of the disease, clinical manifestation of the disease and treatment. Dr. Moss published 180 scientific papers just on the long QT syndrome among over 750 papers in his career.
He very much appreciated the role of electrocardiogram (ECG) in daily practice and in research. His long‐standing interest in the LQTS led to numerous papers focused on the importance of QT interval in diagnosis and prognosis of these patients and subsequently influenced the field of drug‐induced QT prolongation.
Dr. Moss was excellent clinician, very devoted to his patients and he was able to combine his clinical activity with a very successful academic career full of teaching and prime research. His leadership, best seen through the studied and trials mentioned above, was truly unique. He always was able to trigger good discussions and led them in the right directions capitalizing on wisdom of numerous members of research teams. We miss him and his insight.
REFERENCES
- Bigger Jr., J. T. , Fleiss, J. L. , & Rolnitzky, L. M. (1986). Prevalence, characteristics and significance of ventricular tachycardia detected by 24‐hour continuous electrocardiographic recordings in the late hospital phase of acute myocardial infarction. American Journal of Cardiology, 58, 1151–1160. 10.1016/0002-9149(86)90374-7 [DOI] [PubMed] [Google Scholar]
- Kleiger, R. E. , Miller, J. P. , Bigger Jr., J. T. , & Moss, A. J. (1987). Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. American Journal of Cardiology, 59, 256–262. 10.1016/0002-9149(87)90795-8 [DOI] [PubMed] [Google Scholar]
- Kutyifa, V. , Beck, C. , Brown, M. W. , Cannom, D. , Daubert, J. , Estes, M. , … Moss, A. J. (2017). Multicenter Automatic Defibrillator Implantation Trial‐Subcutaneous Implantable Cardioverter Defibrillator (MADIT S‐ICD): Design and clinical protocol. American Heart Journal, 189, 158–166. 10.1016/j.ahj.2017.04.014 [DOI] [PubMed] [Google Scholar]
- Moss, A. J. , Bigger Jr., J. T. , & Odoroff, C. L. (1987). Post‐infarct risk stratification. Progress in Cardiovascular Diseases, 29, 389–412. 10.1016/0033-0620(87)90014-4 [DOI] [PubMed] [Google Scholar]
- Moss, A. J. , Hall, W. J. , Cannom, D. S. , Daubert, J. P. , Higgins, S. L. , Klein, H. , … Heo, M. (1996). Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. New England Journal of Medicine, 335, 1933–1940. 10.1056/NEJM199612263352601 [DOI] [PubMed] [Google Scholar]
- Moss, A. J. , Hall, W. J. , Cannom, D. S. , Klein, H. , Brown, M. W. , Daubert, J. P. , … Zareba, W. (2009). Cardiac‐resynchronization therapy for the prevention of heart‐failure events. New England Journal of Medicine, 361, 1329–1338. 10.1056/NEJMoa0906431 [DOI] [PubMed] [Google Scholar]
- Moss, A. J. , & McDonald, J. (1971). Unilateral cervicothoracic sympathetic ganglionectomy for the treatment of long QT interval syndrome. New England Journal of Medicine, 285, 903–904. 10.1056/NEJM197110142851607 [DOI] [PubMed] [Google Scholar]
- Moss, A. J. , Osborne, R. , Baue, A. , Lees, R. , Jamison, R. , & Spann, J. (1962). Closed‐chest cardiac massage in the treatment of ventricular fibrillation complicating acute myocardial infarction. New England Journal of Medicine, 267, 679–681. 10.1056/NEJM196210042671401 [DOI] [PubMed] [Google Scholar]
- Moss, A. J. , Schuger, C. , Beck, C. A. , Brown, M. W. , Cannom, D. S. , Daubert, J. P. , … Zareba, W. (2012). Reduction in inappropriate therapy and mortality through ICD programming. New England Journal of Medicine, 367, 2275–2283. 10.1056/NEJMoa1211107 [DOI] [PubMed] [Google Scholar]
- Moss, A. J. , Schwartz, P. J. , Crampton, R. S. , Tzivoni, D. , Locati, E. H. , MacCluer, J. , … Garson, A. Jr. (1991). The long QT syndrome. Prospective longitudinal study of 328 families. Circulation, 84, 1136–1144. 10.1056/NEJMoa1211107 [DOI] [PubMed] [Google Scholar]
- Moss, A. J. , & Schwartz, P. J. (2005). 25th anniversary of the International long-QT Syndrome Registry: An ongoing quest to uncover the secrets of long-QT syndrome. Circulation, 111, 1199–1201. 10.1056/NEJMoa1211107 [DOI] [PubMed] [Google Scholar]
- Moss, A. J. , Zareba, W. , Hall, W. J. , Klein, H. , Wilber, D. J. , Cannom, D. S. , … Andrews, M. L. (2002). Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. New England Journal of Medicine, 346, 877–878. 10.1056/NEJMoa013474 [DOI] [PubMed] [Google Scholar]
- Zareba, W. , Klein, H. , Cygankiewicz, I. , Hall, W. J. , McNitt, S. , Brown, M. W. , … Moss, A. J. (2011). Effectiveness of cardiac resynchronization therapy by QRS morphology in the Multicenter Automatic Defibrillator Implantation Trial - Cardiac Resynchronization Therapy (MADIT-CRT). Circulation, 123, 1061–1072. 10.1161/CIRCULATIONAHA.110.960898 [DOI] [PubMed] [Google Scholar]