Book Review

Arrhythmias

N Engl J Med 1995; 332:130January 12, 1995

Article

Arrhythmias
Edited by John A. Kastor. 430 pp., illustrated. Philadelphia, W.B. Saunders, 1994. $85. ISBN: 0-7216-4228-4

In these busy clinical times, a quick, readily applicable remedy for a problem is appealing. Although Arrhythmias provides such solutions, the book is very much more; it is an authoritative, clearly written presentation of the common arrhythmias and some not so common ones. Each chapter is written by someone who is not only an authority, but also, in many instances, the person most responsible for our knowledge of the subject.

Dr. Kastor has created this book specifically “for clinicians who are not now nor plan to become clinical electrophysiologists.” The book can be recommended as a source of clear instruction for exactly this group. Not surprisingly, however, since each author is so clearly excited about and interested in the subject about which he is writing (all are men), the depth of the presentation goes beyond that in virtually every case. Although this may detract somewhat from its value to the clinician who wants a quick overview of the subject, the arrangement of the book makes that unlikely, and the authors' excitement makes the book exceptional. If a reader wishes to learn about a specific rhythm, a chapter on that rhythm can easily be found. Each chapter presents the important features of the clinical history and physical examination and details the electrocardiographic features. The prognosis associated with each rhythm is discussed, and an approach to management can be found in each chapter. All the chapters are well organized, clearly written, and well illustrated, with examples that are relevant and helpful. The references are extensive and appropriate.

Clinical cardiologists, internists, and primary care physicians will find that this book meets their need to understand and manage cardiac arrhythmias. It is also appropriate for fellows in cardiology or cardiac arrhythmia and for specialists in arrhythmias. It is difficult to find weaknesses. Efforts to keep the chapters uniformly organized lead to some redundancy in the discussions of specific rhythms. Occasionally, an author presents treatment options without specifying a preference. In addition, some cardiac rhythms are given too much weight in relation to their general clinical importance — for example, accelerated junctional rhythm, junctional ectopic tachycardia, and sinus-node and atrial-reentry rhythms. Although these rhythms are important, they are less likely than others to be part of the clinical management issues regularly faced by a practicing clinician.

An interesting feature of the book is the attention given to the rich history of arrhythmias, which the first chapter discusses. A historical perspective is featured in each of the subsequent chapters. Yet the nearly exponential expansion of our understanding of arrhythmias, which these chapters explain, is largely the result of the work of many of the contributors to this book. This book provides the reader with the opportunity to learn the authors' most recent thoughts about the very subject they have helped develop.

John McAnulty, M.D.
Oregon Health Sciences University, Portland, OR 97201