Clinical Cardiac Electrophysiology; Techniques and Interpretations

Jack Stanko

This book focuses on the clinical aspects of cardiac electrophysiology testing and interpretation. It is the second edition, and the first edition published in 1979 was much shorter. The purpose of this text is twofold: (1) to provide a better understanding of this field to internists and clinical cardiologists, and (2) to provide the essential basic information needed to perform and interpret these studies. The text is geared toward the serious student at any level (physician, nurse, technician) in clinical cardiac electrophysiology. Given the highly technical basis of this information, I do not believe it is well suited for persons outside the area of cardiology. The text is well written and has many excellent electrophsyiology tracings, figures, and tables. It is well organized, with more than adequate quantity and quality of references. Some chapters are quite long, and new topics such as devices could have been discussed in their own chapters. Overall, this single-authored book is a tremendous accomplishment by a leading and eminent figure within the field of cardiac electrophysiology. This edition, although much more expanded than the first, still underemphasizes some important areas of clinical electrophysiology, i.e., devices and ablation. However, this may reflect the growth of this field rather than any shortcomings of the author. It is an excellent intermediate text that will be enjoyed and cherished by many students of the field regardless of their level of expertise.

From The Critics

New edition of a text that provides the early career stage clinical electrophysiologist with an electrophysiologic approach to arrhythmias. It stresses the methodology required to define the mechanism and site of origin of arrhythmias so that safe and effective therapy can be utilized. In the 14 chapters, Josephson (Harvard Medical School) discusses the technical and general aspects of electrophysiologic investigation, sinus node function, atrioventricular conduction and miscellaneous related phenomena, intraventricular conduction disturbances, ectopic rhythms and premature depolarizations, supraventricular tachycardias, atrial flutter and fibrillation, preexcitation syndromes, recurrent ventricular tachycardia, catheter and surgical ablation, and evaluation of antiarrhythmic agents and of electrical therapy. Annotation c. Book News, Inc., Portland, OR (booknews.com)

Booknews

Provides the internist and clinical cardiologist with the means to understand the capabilities and limitation of clinical cardiac electrophysiologic techniques so as to enable them to select patients who will benefit from such studies; and provides the essential information to understand the technical aspects of performing electrophysiologic studies in order to perform safe and reproducible studies which can provide the basis for clinical decision making. Annotation c. Book News, Inc., Portland, OR (booknews.com)

From The Critics

Reviewer: John F. Moran, MD(Loyola University Stritch School of Medicine)
Description: This is the third edition of a popular book on electrophysiology. It covers general techniques, bradycardias, arrhythmias due to sinus node or atrial ventricular conduction defects, and supraventricular and ventricular tachycardias. An evaluation of antiarrhythmic drugs and electrical therapy for arrhythmias is provided.
Purpose: The purpose is to present an electrophysiologic approach to understanding arrhythmias with emphasis on the techniques needed to define the mechanisms to these arrhythmias.
Audience: The book is designed for electrophysiology fellows and any physicians interested in arrhythmia analysis. The author states the book is designed for the "budding electrophysiologist."
Features: The contents are virtually identical to what was presented in the second edition. The table of contents shows that the historical perspectives have now been added to the Forward instead of Chapter 1. The equipment chapter shows some new catheters; for example, the basket-like catheter. The discussion of cardiac tamponade as a complication has been increased from three patients to ten patients for an incidence of 0.08%. Almost all of the patient tracings presented are taken from the second edition, although some now are somewhat smaller than they were in the second edition. There are very few newer patient tracings. Most of the chapters have a few more references added. There is new material on activation mapping utilizing the Carto System. There are several colored pictures of Carto maps in the center of the text demonstrating the maps for supraventricular tachycarida, atrial flutter, atrial tachycardia, bypass tracts, etc. The use of the Carto System has been added to the general method for ventricular tachycardia mapping. The use of the signal averaging electrocardiogram as described in the MUST Trial is reviewed and its use and prediction of mortality is discussed. The chapter on atrial fibrillation and atrial flutter contains some new information on Carto mapping demonstrating some differences in wave fronts in atrial fibrillation when the rhythm is sustained versus nonsustained atrial fibrillation. The use of ablation and the intracardiac defibrillator has changed the practice of electrophysiology; however, there is no mention of the atrial defibrillator currently experimental. The antiarrhythmic drugs Solatol, Dofetilide, and Ibutilide are added to the chapter on antiarrhythmic drug therapy.
Assessment: This was an excellent book at the second edition level published in 1993. This continues in the third edition with excellent illustrations. although many of them have been downsized from the second edition. It is also fascinating to see how much the basic electrophysiologic work done in the late 1970s and 1980s is still a standard in electrophysiology some 20 years later. It may also be true that programmed electrical stimulation in electrophysiology is done less often because of the use of the intracardiac defibrillator. The chapter entitled, "Myocardial Infarctions, Special Considerations" has been dropped. "Guidelines for Permanent Pacing for Bradycardia" has been updated from the 1991 reference. Overall, there are a few more references and a few more illustrations added to the third edition. However, the main justification for the third edition is that the second edition from 1993 is probably out of print.

3 Stars from Doody