Book Review

Marriott's Practical Electrocardiography

N Engl J Med 1995; 332:690March 9, 1995

Article

Marriott's Practical Electrocardiography
Ninth edition. By Galen S. Wagner. 434 pp., illustrated. Baltimore, Williams & Wilkins, 1994. $32. ISBN: 0-683-08604-9

Although a ninth edition, Marriott's Practical Electrocardiography is “new” because both Professor Galen S. Wagner of Duke University Medical Center and Professor Henry J.L. Marriott have written the book. Its chief advantage, as compared not only with the previous editions but also with other textbooks of electrocardiography, is its clear and useful explanation of the normal electrocardiogram, which provides a handy standard by which one may gauge abnormalities. The clear format of the book, which includes an excellent index and lucid definitions of concepts and terms, makes for comfortable reading.

Marriott's Practical Electrocardiography stands out from other textbooks of electrocardiography because it clearly details the common errors in lead placement. It does not mention, however, that the UP interval is the standard isoelectric line (or the TP interval, if the UP interval is unmeasurable). Some areas could have been discussed more thoroughly, including the polarity of the frontal plane, the diagnosis of clockwise and counterclockwise rotation, determination of the axis, and fine adjustment of the axis. Unfortunately, there is no description of U-wave inversion in ischemia.

Holter monitoring is presented very well, but the unreliability of this method in measuring depression or elevation of the ST-T segment or the changes in leads aV_R and III in acute pericarditis is not mentioned. The fine illustrations of the electrocardiographic diagnosis of hypertrophic cardiomyopathy complement a lucid description in the text. Sinus tachycardia — which most clinicians consider the electrocardiographic hallmark of pulmonary embolism — and the standard lead I sign of emphysema are also not discussed. The book does not indicate the arrhythmia that digoxin toxicity does not cause (Mobitz type II second-degree atrioventricular block), but more important, it lists the arrhythmia digoxin toxicity is likely to cause.

One excellent aspect of the book is the approach to the analysis of arrhythmias. With support from useful illustrations, this discussion of the basis of most arrhythmias — the reentry mechanism — is cogent and clear. The authors demonstrate how to differentiate between ventricular rhythm and supraventricular rhythm with aberrant ventricular conduction, including recent developments; this enlightening discussion will help clinicians develop competence in making this crucial differentiation. In addition, Q-wave criteria and diminished R-wave criteria as a basis for the diagnosis of infarction are well explained, but in this edition, unlike the previous one, the authors do not stress that Q-wave and non–Q-wave infarctions are no longer considered transmural and subendocardial infarctions, respectively — a misconception that still persists among clinicians.

This is a high-quality book written with considerable clarity. It is not, however, for beginners. People new to the field might refer to Leo Schamroth's An Introduction to Electrocardiography (Boston: Blackwell Scientific, 1976). Experienced clinicians will find that Marriott's suits their needs.

Hans Traberg, M.D.
Northridge, CA 91325