Book Review

Paediatric Cardiac Arrhythmias

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

Article

Paediatric Cardiac Arrhythmias
Edited by Christopher Wren and Ronald W.F. Campbell. 368 pp. New York, Oxford University Press, 1996. $125. ISBN: 0-19-262295-1

Arrhythmias are a common and often perplexing problem for physicians involved in the care of infants, children, and adolescents. Most arrhythmias in young patients are benign, but some may cause severe symptoms and even sudden death. In this era, as pediatric cardiologists have become less comfortable with managing arrhythmias and increasingly dependent on their colleagues in electrophysiology, there are few resources to inform clinicians about current approaches to the evaluation and treatment of children with arrhythmias. For these reasons, this book is welcome. The book is pleasantly written and may be read in its entirety or used as a resource for specific issues by both primary care physicians and pediatric cardiologists. In the preface, the advantage of this textbook over journals and Internet sources is said to be that it offers information that has been sorted, assessed, edited, and presented by thoughtful experts to assist others in providing care to patients.

The editors have made a concerted effort to define terms and concepts in a consistent manner. The early chapters present a general discussion of arrhythmias that includes data on prevalence, clinical presentations, electrophysiologic principles, and invasive and noninvasive diagnostic studies. Eight chapters discuss specific types of arrhythmias, including fetal arrhythmias and those associated with surgery. The chapters concerning ventricular arrhythmias are particularly helpful. They discuss the existing literature and the difficulties in applying such studies to individual patients, and they provide a practical strategy for assessing young patients with ventricular arrhythmias.

After a chapter on the pharmacology of antiarrhythmic drugs, the one entitled “Practical Use of Antiarrhythmic Drugs” includes an interesting chart as a guide to drug therapy for specific arrhythmias that is described as a “distillation of the experience of many colleagues from around the world.” Although this type of chart is not a dogmatic directive, it does provide a well-referenced guide for physicians.

The chapter describing radiofrequency ablation is a helpful introduction for trainees in electrophysiology or for physicians who refer patients for these procedures. The chapter on surgery for arrhythmias reviews a field that has a small but important role in difficult situations. The chapter on pacemakers discusses general indications for their use and explanations of the coding system for these devices. The final chapter addresses syncope in pediatric patients and provides an excellent summary of the physiology, diagnosis, and treatment of this problem.

This excellent book has few limitations. One unresolved issue is the long-term treatment of children or adolescents with recurrent supraventricular tachycardia. Readers should be aware that approaches to treatment (with drugs, ablation, or observation) may vary among different countries and that such experiences are not uniform. Furthermore, a chapter on the emergency evaluation and treatment of cardiac arrhythmias would have been a helpful addition. The chapters on antiarrhythmic drugs use the schema known as the Sicilian Gambit to characterize drug actions according to their effects on ion channels and membrane receptors. Although the Sicilian Gambit is useful, the Vaughan Williams classification should also have been included, as it remains a commonly used system and is referred to in other chapters. The chapter concerning fetal arrhythmias would have been improved by a more complete discussion of the use of medications, especially the unique role of the delivery of drugs to the mother in order to treat the fetus. Other minor problems include a tracing demonstrating 2:1 atrioventricular block that is labeled as Mobitz II block, which requires a His-bundle recording for differentiation, and a reference to atrioventricular dissociation as atrioventricular “association.”

The book is extremely well referenced, with both up-to-date citations and older and classic citations. Even the many useful tables are filled with references to guide the reader toward further review. Although this is a multiauthored book, the chapters are reasonably consistent, with excellent cross-referencing. The chapters average 20 pages, and each can be read in a single sitting. This book should be welcomed by all who encounter children or adolescents with arrhythmias. It is a superb book for all pediatric cardiologists, a valuable one for primary care physicians, and an excellent overview and review for those in pediatric electrophysiology.

Bruce G. Hardy, M.D.
Michael J. Silka, M.D.
Oregon Health Sciences University, Portland, OR 97201-3098