Book Review

Practical Management of Cardiac Arrhythmias

N Engl J Med 1997; 337:864-865September 18, 1997

Article

Practical Management of Cardiac Arrhythmias
Edited by Nabil El-Sherif and Jean Lekieffre. 348 pp. Armonk, N.Y., Futura, 1997. $95. ISBN: 0-87993-652-5

Practical Management of Cardiac Arrhythmias, which is intended to offer “a concise, yet all-inclusive, review of the up-to-date strategies in the management of cardiac arrhythmias,” has three sections, each on a different aspect of therapy: pharmacologic strategies, catheter-ablation techniques, and management with surgery and implantable cardioverter–defibrillators. Rather than a comprehensive overview of the evaluation and treatment of arrhythmias, this book consists of selected topics in management.

The first section of the book, on pharmacologic treatment of supraventricular and ventricular tachycardias, rather nicely reviews certain controversies in the management of arrhythmias. For example, the difficulties in finding effective medical treatment for vasovagal syncope and the problems in evaluating efficacy due to the lack of reproducibility in tilt-table testing are well explained. The uncertainties in the evaluation and treatment of patients with hypertrophic cardiomyopathy or nonsustained ventricular tachycardia and ischemic heart disease are also covered in detail. The chapters on the development of new antiarrhythmic drugs and on the long-QT syndrome review advances in our understanding of ion-channel biology and are worthwhile, up-to-date reviews. Throughout this section, however, there is less detail on practical medical management than one might expect. For example, atrial fibrillation is the only supraventricular tachycardia for which medical management is discussed, whereas for ventricular arrhythmias, risk stratification is discussed in more detail than the use of antiarrhythmic drugs.

Although atrial flutter is included in the section on catheter ablation, medical management and cardioversion are discussed there as well. Somewhat surprisingly, the book fails to cover the termination of atrial flutter with ibutilide, but it does discuss some outmoded therapies (high-dose quinidine) and some that are unavailable (intravenous propafenone). The last section of the book covers the results of mapping and surgery for ventricular arrhythmias at two different centers and gives an overview of surgical approaches to supraventricular tachycardias. However, the surgical management of arrhythmias is declining steadily as catheter-ablation techniques have improved. Topics related to implantable cardioverter–defibrillators include the shift to nonthoracotomy techniques for implantation, techniques of anti-tachycardia pacing, evolving indications for defibrillators, and investigational devices for atrial arrhythmias.

The optimal audience for the book may not be clear from the title. One might expect that the book contains practical guidelines for managing arrhythmias, but it is actually geared toward specialists in the field. A primary care physician looking to expand his or her knowledge of the medical management of arrhythmias would probably be somewhat disappointed, as there are really no specific guidelines or suggestions for treating the common arrhythmias seen in clinical practice. Many of the drugs discussed are not available in the United States (e.g., intravenous cibenzoline). The tables concerning the choice of antiarrhythmic drugs for atrial fibrillation would be confusing to physicians unfamiliar with the Sicilian Gambit, which is a new approach to the classification of antiarrhythmic drugs based on their effects on the mechanisms of arrhythmias.

The most appropriate readership for this book would be electrophysiologists and other cardiologists with a particular interest in arrhythmias who are looking for a concise review of the topics covered. In particular, the book covers nicely recent advances in the treatment of arrhythmias and current controversies in their management.

Anne B. Curtis, M.D.
University of Florida, Gainesville, FL 32610-0277