Book Review

Sudden Cardiac Death

N Engl J Med 1994; 330:1324May 5, 1994

Article

Sudden Cardiac Death
Edited by Mark E. Josephson. 432 pp., illustrated. Boston, Blackwell Scientific, 1993. $74.95. ISBN: 0-86542-199-4

For whom is this book intended? It would not be very toothsome for a family doctor or an internist, but a pediatrician would savor Victoria Fedder's clear, useful discussion of the sudden infant death syndrome. A practicing cardiologist might acquire a few insights from some of the more detailed chapters on specialized topics. However, one might easily ask, Does this book have a clear message?

The hodgepodge of presentations, among which some are excellent, some adequate, and some boring, works the reader too hard. Although the preface states that “this text was compiled to provide the most current information about the pathophysiology of sudden cardiac death and new treatment modalities,” the editor has made little effort to develop the theme of sudden cardiac death for an audience of potentially interested clinicians and researchers. There are opportunities to discuss fascinating topics, ranging from cardiac death in utero through inherited sudden death to coronary catastrophes in middle age, but nothing spectacularly new emerges to whet the slogging reader's appetite.

The book's weakest point is its omission of the long-QT syndrome. Except for very limited attention in the index and superficial comment in the text on electrophysiologic treatment, on the relation to sudden infant death syndrome, and on demand pacing to avert bradycardia, there is no detailed discussion of this important form of inherited sudden death or its treatment. The recent publication of results from two international registries relating to the long-QT syndrome should have prompted a more extensive examination of the syndrome, if not its incorporation into a separate chapter. Surely such treatment methods as β-adrenergic blockade, pacing to interrupt long short pauses that predispose patients to torsade de pointes, left cervicothoracic sympathectomy, and automatic implantable cardioverter-defibrillators deserve more than passing mention. How much better to have gotten an insightful essay about the long-QT syndrome from a talented, well-respected investigator such as Peter Schwartz or Michael Vincent.

To add insult to injury, in an otherwise fine presentation William Roberts omits the long-QT syndrome as a cause of sudden death. A panel is omitted from a figure in the article by Schwartz and associates. Boris Surawicz provides a nice meta-analysis of β-adrenergic blockade that is marred by the lack of a graph to display the information. The discussion of therapeutic trials of drugs after acute myocardial infarction is well presented, with attention to subgroups of patients at variable risk.

The book has a nicely designed hard cover. The length of the presentations is quite uneven, ranging from 10 to nearly 50 pages. More editorial attention to word-weight ratios would have benefited the reader. The concept of a new book on sudden death is laudable, and much of the material is well referenced. Although “this text is intended to provide the reader with the most thorough understanding” and “the most appropriate methods to prevent and treat,” important new insights and topics are unfortunately omitted. Neither the academic specialist nor the practitioner will find the last word or the quintessentially pragmatic therapeutic gesture within these covers.

Richard S. Crampton, M.D.
University of Virginia Hospital-West Private Clinics, Charlottesville, VA 22908