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Myocardial Repolarization: From Gene to Bedside FREE TO VIEW

Fred Kusumoto
Chest. 2003;124(5):2039. doi:10.1378/chest.124.5.2039
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By Ali Oto and Gunter Breithardt, eds. New York, NY: Futura Publishing, 2001; 404 pp; $105.00

Over the last 20 years, there has been a greater appreciation of the clinical importance and complexity of myocardial repolarization. The landmark Cardiac Arrhythmia Suppression Trial showed that drugs that affect myocardial depolarization actually were associated with increased mortality due to proarrhythmic effects, and over the past decade scientists and pharmaceutical companies have focused on developing antiarrhythmic drugs that delay myocardial repolarization. In Myocardial Repolarization: From Gene to Bedside, Oto and Breithardt provide a timely and comprehensive review of both the basic electrophysiology and the clinical aspects of myocardial repolarization. The editors have gathered an internationally renowned group of more than 50 contributors who discuss specific aspects of repolarization in 25 succinct chapters, each approximately 10 to 15 pages in length. This format allows one or two chapters to be read easily in an evening. In general, the book is well-illustrated, and the editors have done an excellent job in providing chapters that have a uniform structure throughout with minimal subject overlap.

The book is broadly divided into three sections. The first portion describes the basic ionic mechanisms of myocardial repolarization. In particular, I enjoyed Kaab and Nabauer’s fascinating discussion of ion channel population changes in the setting of myocardial hypertrophy. The second section of the book focuses on clinical techniques for evaluating myocardial repolarization. Methods for using the QT interval to evaluate ventricular repolarization, including newer concepts, such as QT interval dynamicity and dispersion, are discussed comprehensively. Several chapters are devoted to the emerging role of T-wave alternans as an indicator of unstable ventricular repolarization and as a possible marker for sudden cardiac death. The third section of the book discusses clinical syndromes associated with myocardial repolarization abnormalities. Extensive discussions of congenital long QT syndrome and acquired long QT syndrome are provided. The chapter on the Brugada syndrome is an extremely well-written and concise summary of this recently recognized clinical entity. In addition, Breithardt and colleagues provide an interesting discussion of the links between sudden infant death syndrome and myocardial repolarization abnormalities.

My only criticism of the book is that there is no discussion of atrial repolarization. Repolarization in atrial tissue is characterized by a less prominent plateau phase than ventricular tissue due to a relative increase in potassium ion permeability because of the presence of an ultrarapid component of the delayed rectifier current. Agents that affect the ultrarapid component of the delayed rectifier current hold promise for drug therapy that is atrial tissue-specific. Drugs may be developed that can effectively treat atrial fibrillation while minimizing the risk of ventricular proarrhythmia.

In summary, Myocardial Repolarization: From Gene to Bedside is a wonderful book that provides a timely and comprehensive review of myocardial repolarization. The book would primarily be of interest to an electrophysiologist, or to the cardiologist or health-care professional with a specific interest in electrophysiology. I thank the editors for putting together a book that was a true pleasure to read.




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