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Management of Cardiac Arrhythmias FREE TO VIEW

Alexander Chen, MD; Fred M. Kusumoto, MD
Chest. 2004;125(4):1597. doi:10.1378/chest.125.4.1597-a
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By Leonard I. Ganz, MD, ed. Totowa, NJ: Humana Press, 2002; 527 pp; $135.00

The ongoing revolution in cardiac electrophysiology (EP), including the development of methods for device implantation and percutaneous-based approaches, has propelled this field from its investigative origins to a mainstream therapeutic subspecialty of cardiology. Many new options have supplanted traditional pharmacologic strategies. In parallel with this astonishing change in the treatment of arrhythmias is the welcome appearance of a second edition of Management of Cardiac Arrhythmias.

This multiauthored work opens with chapters describing the historical developments that led to modern cardiac EP and reviewing diagnostic tools from ambulatory monitoring to the invasive EP study. Subsequent topics include both the diagnostic and therapeutic approaches to supraventricular tachycardia, atrial fibrillation/flutter, and syncope. The coverage then shifts to areas such as bradyarrhythmias and associated indications for pacing, the evaluation and treatment of ventricular tachycardia and ventricular fibrillation, and miscellaneous topics such as long QT syndrome, hypertrophic cardiomyopathy, and arrhythmias in the pediatric and pregnant populations.

Eight chapters are dedicated to the various facets of atrial fibrillation and ventricular arrhythmias, reflecting the expanded therapeutic options now available. Authorities in their fields address the diagnostic workup for atrial fibrillation, and its management in terms of rate control, anticoagulation, and antiarrhythmic therapy. Cardiologists will welcome the chapters on the nonpharmacologic treatment of atrial fibrillation/flutter and catheter-based cures of atrial fibrillation.

While the text is not detailed enough to serve as an authoritative guide for the electrophysiologist, the well-organized and succinctly written format establishes a useful clinical framework for the nonelectrophysiologist, thus serving to promote better management and referrals for the primary care provider and the general cardiologist. Multiple viewpoints that are representative of the EP community are embodied in this work, and the text will surely pique the curiosity of the reader and serve as a springboard for additional education, particularly with the availability of each chapter’s extensive references. Furthermore, the text is accompanied by very useful graphs, electrocardiograms, photographs, and algorithms.

Unfortunately, because of the length of time required for publishing a comprehensive review of a rapidly changing field, recent data from important trials could not be included. For example, the second Multicenter Automated Defibrillator Implantation Trial, which further established the role of implantable cardioverter-defibrillators (ICDs) in the primary prevention of ventricular arrhythmias, is not included. While there is an ongoing debate concerning the cost implications in the use of ICDs, it would have been very germane to the discussion in Chapter 14 of the role of ICD therapy in this context. However, some topics, such as upcoming catheter ablation technologies, research efforts in dual-lead atrial pacing for atrial fibrillation, and mapping of ventricular tachycardia in the context of radiofrequency ablation, exceed the requirements of the nonelectrophysiologist. In addition, those readers hoping to learn of the molecular breakthroughs in EP will have to look elsewhere. Paradoxically, another deficiency in a text that seemingly is aimed at the generalist is the lack of detailed chapters regarding pacemaker care or lifestyle restrictions.

This multiauthored work is a welcome addition to the library of the nonelectrophysiologist. Its skillful editing has resulted in a well-balanced text that is suitable for both the general practitioner and cardiologist who encounter arrhythmias in their everyday practice. While covering the basic diagnostic and therapeutic issues, this book also touches on the intricacies of the EP world and provides a better understanding of what the electrophysiologist might offer the patient.




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