The text is broadly divided into seven sections. The first section discusses mechanisms and diagnosis of atrial arrhythmias. The chapter on mechanisms of AF is especially well written and in-depth, and can be followed easily by a student of electrophysiology. The next section deals with the prevention of atrial tachyarrhythmias in patients with AV block and sinoatrial node dysfunction; the authors discuss the retrospective and prospective data that support the use of physiologic pacing to prevent atrial arrhythmias. Section three discusses more novel therapies for arrhythmia prevention, including left atrial pacing, biatrial pacing, and single- and dual-site right atrial pacing, which are clearly emerging as viable rhythm control alternatives. The fourth section, automatic mode switching, is very useful because there is detailed information on the different mode switching algorithms utilized by several device manufacturers, from the popular Medtronic (Minneapolis, MN) and Guidant Corporation (St. Paul, MN) systems to the less commonly used ELA Medical (Paris, France) pacemakers. No other text presents this information so concisely. Section five discusses technological advances in devices and atrial lead technology and will be of use to the device specialist. The sixth section discusses hybrid therapy: combining His bundle ablation and pacing with antiarrhythmic drugs to prevent and treat AF. A chapter devoted solely to antiarrhythmic drug therapy could have been useful to get the reader up to speed, although the intended audience should be familiar with this literature. The final section discusses termination of atrial arrhythmias including antitachycardia pacing, internal atrial defibrillation, and advances in internal and external cardioversion. The chapter on the management of AF in patients with dual-chamber implantable cardioverter defibrillators (ICDs) capable of providing both atrial and ventricular therapies is especially well done. This chapter is timely and relevant to clinical practice, since atrial arrhythmias are common in patients requiring an ICD; because of this concern, in the United States 75% of the ICDs implanted are dual-chamber devices.2–
However, a recently reported trial3
found that dual-chamber ICDs are associated with a statistically significant increase in death and hospitalization for new or worsened heart failure compared to single-chamber ICDs.