Book Review

Fighting Sudden Cardiac Death: A Worldwide Challenge

N Engl J Med 2001; 345:927September 20, 2001

Article

Fighting Sudden Cardiac Death: A Worldwide Challenge
Edited by Etienne Aliot, Jacques Clementy, and Eric N. Prystowsky. 724 pp., illustrated. Armonk, N.Y., Futura, 2000. $125. ISBN: 0-87993-460-3

This book is an up-to-date, comprehensive review of the latest research on sudden death from cardiac causes and of the optimal management for its prevention. Sudden death from cardiac causes is a serious public health problem, particularly in the industrialized world. Our knowledge of its causes is increasing, as is our understanding of the genetic basis and mechanisms of the heritable syndromes that can lead to it. Nevertheless, we cannot accurately identify the majority of patients who are at risk for sudden death, most of whom have ischemic heart disease. In addition, in many patients, the mechanisms leading to sudden death from cardiac causes are incompletely understood. Clinical trials designed to test strategies to improve survival have provided important guidelines for management, but risk stratification still requires improvement, and new ways to improve outcomes even further should be tested. Thus, a review of the latest developments in this area is timely.

In their preface, the editors state that it was their intention to analyze the problem of sudden death from cardiac causes from a variety of perspectives, from its pathophysiology to the results of randomized clinical trials. Indeed, the book covers a wide array of topics. For instance, the initial chapters cover epidemiology and mechanisms, with discussions of the autonomic nervous system, genetics, after-depolarizations, and regional differences in the electrophysiology of ventricular cells in relation to the development of ventricular fibrillation. Other chapters cover sudden death and the athlete, arrhythmogenic right ventricular dysplasia, repolarization syndromes (such as the long-QT syndrome and the Brugada syndrome), risk stratification in patients with and without ischemic heart disease, and treatment, primarily the use of implantable cardioverter–defibrillators. The role of medical therapy in the prevention of sudden death from cardiac causes is also covered, with a review of the use of amiodarone, beta-blockers, and angiotensin-converting–enzyme inhibitors.

It is a real advantage to be able to review easily topics as diverse as idiopathic ventricular fibrillation and the problem of sudden death in hypertrophic cardiomyopathy, mitral-valve prolapse, and repaired congenital heart disease, all in one book. In addition, the discussions in the book are current and include recent information from basic research as well as clinical trials; the references, for the most part, cover publications through 1999.

Some topics in the book are of questionable relevance. For instance, the development of evidence-based guidelines in general is discussed, and the telephone numbers for emergency medical services in the various countries of Europe are provided. On the other hand, the book covers many timely topics of interest to those who are dedicated to reducing the incidence of sudden death from cardiac causes. I found the chapters on arrhythmogenic right ventricular dysplasia, the Brugada syndrome, and the long-QT syndrome particularly informative. For each of these disorders, genetic considerations, ion-channel defects, mechanisms of arrhythmias, and recommendations for treatment are covered in detail, and observations in series of patients are provided.

The book will appeal primarily to physicians who specialize in electrophysiology and to cardiologists who have a particular interest in the prevention of sudden death. Internists and allied health professionals will probably find that the book contains more detail, particularly at the level of basic research, than is essential for general patient care, unless they have a specific interest in a particular topic.

Anne B. Curtis, M.D.
University of Florida, Gainesville, FL 32610
curtis@medicine.ufl.edu