Cardiac arrhythmias are among the most complex and challenging disorders encountered by physicians in clinical practice, and research in this field continues to progress rapidly. Cardiologists face a daunting task in keeping up with the broad range of these developments, whether in understanding of the mechanisms and manifestations of arrhythmias or in application of new technologies and therapies. Two recently published books aid in this effort.
Cardiac Arrhythmias and Device Therapy: Results and Perspectives for the New Century takes a broad approach, with emphasis on including current “hot spots” in the field. The editor's preface states, “The final decades of the last century have been a period of expansive growth for the electrophysiological management of cardiac arrhythmias. Rapid application of technological advances within clinical practice has been the main focus of these extraordinary developments, rendering the communication and exchange of ideas in this field paramount.” The goal of this book is to facilitate that communication. To this end, the editor has assembled an impressive roster of experts from around the world to produce a comprehensive and useful book.
The book is divided into 8 sections. The first section covers basic and clinical electrophysiology in 11 chapters that discuss such topics as T-wave alternans, modeling of defibrillation thresholds, therapeutic and bedside use of adenosine triphosphate, and long QT syndrome. The next 3 sections consider atrial fibrillation, which has been called the “arrhythmia of the 1990s,” thoroughly updating the developments in treatment and preventive modalities, including ablation, defibrillation, and pacing.
Section 5 covers various aspects of defibrillator therapy. It begins by analyzing the impact of defibrillation and discusses topics related to dual chamber implantable cardioverter defibrillators (ICDs), use of ICDs in the pediatric population, and cost analysis of ICD therapy.
The next section discusses the genetics, pathology, risk stratification, and prevention of sudden cardiac death, which remains a major problem throughout the world. Section 7 considers the various aspects of cardiac pacing, a routinely used therapy that has continued to benefit from major technological advances. Of particular interest is the discussion of the latest developments in lead technology and stimulation techniques. The book concludes with a summary of emerging clinical indications for cardiac pacing in such conditions as refractory heart failure, hypertrophic cardiomyopathy, or marked first-degree AV block.
This book will be most useful to readers who already have basic knowledge of arrhythmias. For such readers, the book is helpful in expanding their knowledge and keeping abreast of the latest developments in this broad and rapidly expanding field.
While Ovsyshcher's book primarily considers electrophysiological concepts, Woolsey and Singh focus on the landmark clinical trials that have been conducted to evaluate various antiarrhythmic therapies.
During the past 2 decades, our fundamental concept of ventricular arrhythmias and their management has shifted, based on the results of many well-designed clinical trials. This book presents the most important of these trials, in chronological order, covering a total of 17 trials since the early 1980s. Some of the important trials discussed are the Cardiac Arrhythmia Suppression Trials (CAST), the Electro-physiological Study Versus Electrocardiographic Monitoring (ESVEM) Trial, the Congestive Heart Failure Survival Trial of Antiarrhythmic Therapy (CHF-STAT), the Survival With Oral D-Sotalol (SWORD) Trial, and the Antiarrhythmics Versus Implantable Defibrillator (AVID) Trial. The last chapter of the book previews the recently completed, ongoing, or planned clinical trials, and includes follow-up on completed trials.
This book's strength is its somewhat novel format. In each chapter, one of the designers of the original trial summarizes the protocol and results of the trial. Then a leading authority who was not intimately involved with the trial provides an objective discussion of its strengths and weaknesses, including issues that were raised and questions that were not answered by the trial. Structuring the discussion this way provides deep insight into the value and significance of each study, insight that will help the reader make better clinical decisions regarding appropriate therapy for arrhythmias.
Both of these books provide valuable synthesis of large amounts of information, and either volume would make a good addition to the cardiologist's library.