Book Review

Management of Cardiac Arrhythmias

N Engl J Med 2002; 347:2176-2177December 26, 2002

Article

Management of Cardiac Arrhythmias
(Contemporary Cardiology.) Edited by Leonard I. Ganz. 527 pp., illustrated. Totowa, N.J., Humana Press, 2002. $125. ISBN: 0-89603-846-7

There have been gratifying advances in the treatment of cardiac arrhythmias during the past 20 years. Whereas in the past, pharmacologic therapy was the only real option for most patients with cardiac arrhythmias, the advent of radio-frequency catheter ablation, the implantable cardioverter–defibrillator, and advances in cardiac pacemakers have substantially increased the number of options for the management of arrhythmias. It is important that general cardiologists and primary care physicians stay abreast of the main advances in the field of cardiac electrophysiology and know what treatments are available and when to refer patients to electrophysiologists for optimal therapy.

The goal of Management of Cardiac Arrhythmias is to inform general cardiologists and primary care physicians about these advances in the diagnosis and management of cardiac arrhythmias. This book covers the major areas of interest in electrophysiology. The introductory chapters on the history of electrophysiology and the diagnosis of arrhythmias are followed by chapters on the diagnosis and treatment of supraventricular tachycardias, including atrial fibrillation and flutter, syncope, and permanent pacing, as well as several chapters on ventricular arrhythmias. These chapters include insights from clinical trials on implantable cardioverter–defibrillators, pharmacologic therapy, and catheter ablation. The final chapters cover miscellaneous topics related to ventricular arrhythmias, such as the Brugada syndrome and the long-QT syndrome, arrhythmias during acute myocardial infarction, and arrhythmias in children and during pregnancy.

The book is very well written. Algorithms for evaluation of syncope or long-term pharmacologic management of supraventricular tachycardia graphically outline reasonable approaches to patients with these problems. The illustrations are helpful; informative color plates in the middle of the book show how cardiac mapping helps in the localization of arrhythmias.

The information in the book is accurate and up to date. Experts in electrophysiology give well-reasoned recommendations for evaluation and management, with appropriate suggestions for trials of medical treatment before consideration of ablation and prudent recommendations for ablation as the initial treatment in appropriate patients (e.g., patients with syncope and the Wolff–Parkinson–White syndrome). One might quibble with the recommendation for early use of an implantable loop recorder for the diagnosis of unexplained syncope, when results on tilt-table testing would be diagnostic in many cases and less invasive. Topics related to supraventricular and ventricular arrhythmias are covered in detail, with no major omissions. The only meager area of the book is the coverage of permanent pacing, which receives only one chapter that is limited to a discussion of indications.

Inevitably, there is some redundancy, which results from having several authors cover slightly different areas of the same general topic. For example, in the various chapters on supraventricular arrhythmias, mechanisms and treatment of supraventricular tachycardia are covered both in the chapter on diagnosis of supraventricular tachycardia and the chapter on catheter ablation of supraventricular tachycardia, since knowledge of mechanisms is essential for successful ablation. It is not easy to target the general cardiologist and the primary care physician successfully in the same book. Although neither group specializes in cardiac arrhythmias, the cardiologist is expected to be better versed in details of the diagnosis and management of arrhythmias than the primary care physician. There is, for example, a general introduction to the approach to the patient with palpitations, which is appropriate for the general practitioner. There are also descriptions of reentrant circuits in ventricular tachycardia, which are perhaps beyond the interest of most cardiologists who are not electrophysiologists.

This book would be most appropriate for the physician with a basic understanding of cardiac arrhythmias who seeks a detailed understanding of recent advances in this field, particularly with regard to newer therapeutic techniques and options. A physician whose patient has a particular arrhythmia will find an adequate explanation of the mechanism of the problem and descriptions of the most advanced electrophysiological approaches to evaluation and management, along with a discussion of when referral to an electrophysiologist is appropriate and what to expect from that referral.

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