Book Review

Recent Advances in Cardiology

Clinical Electrocardiography

N Engl J Med 1994; 331:1385-1386November 17, 1994

Article

Clinical Electrocardiography
By Antonio Bayes de Luna. 500 pp., illustrated. Mount Kisco, N.Y., Futura, 1993. $88. ISBN: 0-87993-545-6

At last, a textbook that approaches the ideal for practitioners and teachers of electrocardiography. It takes its place among a large number of books ranging from the supersimplistic, with rigid paradigms that will fail in practice, to quite satisfactory efforts to provide basic or moderately advanced instruction. The author, distinguished in several fields of cardiology, goes to exceptional lengths to form an up-to-date pedagogic basis: more than one fifth of the book is devoted to a discussion of concepts, practical matters, and the range of normal electrocardiograms, and this is followed by concise presentations of sensitivity, specificity, predictive values, Bayes' theorem, and receiver-operating-characteristic curves for interpreting test results. A single detailed figure neatly summarizes all waveform variants and their alphabetic notations. Vector interpretation and XYZ leads, Holter and transtelephonic monitoring, and clinical electrophysiology are clearly presented as logical extensions of cell-membrane electrophysiology and the useful, though widely neglected, hemifield and dipole concepts. Readers are familiarized with traditional and modern auxiliary techniques of expanding practical value, such as wave amplification, esophageal electrocardiography, monophasic action potentials, precordial mapping, and late potentials.

All the foregoing elements, beautifully integrated, provide the firmest foundation for part II, “Abnormal Electrocardiogram,” which succeeds through its artful reliance on diagrams, comprehensive tables (some cleverly illustrated), abundant electrocardiograms, and clear text. In the well-conceived presentations of arrhythmias, the author offers a guide for the perplexed to daunting areas such as junctional arrhythmias, with their increasingly discovered intranodal and extranodal pathways, and the all-important differential diagnosis of wide-QRS tachycardias. Sinoatrial block, a mystery to many, but increasingly prevalent in the aging population, is lucidly explained in only 3 1/2 pages, which include exemplary diagrams and electrocardiograms. “Pacemaker Electrocardiography,” a well-illustrated minimonograph of 12 pages, describes this lifesaving intervention, which is temporary for some and permanent for others.

This exceptional book, a model of textual clarity, will be welcomed by teachers and practitioners of the art and science of electrocardiology. Its abundant illustrations, replete with irresistible slide materials, form a comprehensive atlas that aficionados will love at first sight.

David H. Spodick, M.D., D.Sc.
Saint Vincent Hospital, Worcester, MA 01604