Electrophysiology for Clinicians

by Miguel A. Barrero Garcia; Laurent Macle; Paul Khairy; and Stanley Nattel

Published May 2011

Format: Softcover; eBook

ISBN: 9781935395140

254 pages, Trim Size: 6 X  9 inches

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About:

A concise and practical tool for learning the basic concepts of cardiac electrophysiology, including the diagnosis and management of cardiac arrhythmias, and the indications for patient referral.

Clinically oriented, practical and a useful resource for:    

  • Allied health professionals in the lab and in the clinic
  • Fellows
  • The general physician who needs to know the technical aspects of electrophysiology
  • Anyone on the front line dealing with patients that present with cardiac problems

From the foreword:

Electrophysiology for Clinicians is a superb distillation of the field for clinicians. Authored by leaders in the field, led from the Montreal Heart Institute, it is a clear and concise text emphasizing clinically valuable insights and providing their pathophysiologic basis. Overviews of the fundamentals of arrhythmias and therapies provide the clinician with the necessary foundation for incorporation and retention of new advances into their knowledge base. This book is of great value to health care providers who care for patients with cardiac arrhythmias.

- William G. Stevenson, MD


From the preface:

Electrophysiology for Clinicians unravels the complexities inherent to cardiac electrophysiology, with a focus on diagnosis and management of cardiac arrhythmias and indications for patient referral. With a standardized chapter outline approach that includes key points, color figures, charts, and tables, this handy guide will help demystify the essentials of cardiac electrophysiology for the practicing caregiver.


Authors:

Miguel A. Barrero Garcia, MD, Centre Hospitalier Regional de Trois Rivieres, Quebec

Laurent Macle, MD, Montreal Heart Institute, Montreal, Canada; Université de Montréal

Paul Khairy, MD, PhD, FRCP(c), Canada Research Chair, Electrophysiology and Adult Congenital Heart Disease; Director, Adult Congenital Heart Centre, Montreal Heart Institute; Associate Professor of Medicine, University of Montreal; Research Director, Boston Adult Congenital Heart Service, Harvard University

Stanley Nattel, MD, Professor of Medicine and Paul-David Chair in Cardiovascular Electrophysiology, University of Montreal; Cardiologist and Director of Electrophysiology Research Program, Montreal Heart Institute


Reviews:

Book review from Indian Pacing and Electrophysiology Journal 2012, 1:36
Electrophysiology for Clinicians

Cardiac electrophysiology is a rapidly expanding sub speciality of cardiology with ever increasing new information coming in every day, with quite a few journals devoted to it. Complexity of arrhythmias are sometimes puzzling for a busy cardiologist and so are electrophysiology studies.Electrophysiology for Clinicians is a concise book on basic concepts of cardiac electrophysiology for the busy clinician. In addition to four editors, the book has five contributors, all engaged in active electrophysiology work and research. Unlike most multi authored text books, most of the chapters are either written or co-authored by the editors themselves. This naturally reduces the redundancy between the chapters and maintains a uniformity in the pattern. Overall this book aims to be an excellent tool in the practical management of electrophysiological disorders for the practicing cardiologist.

Reviewed by:
Johnson Francis, MD, DM, FACC, FRCP

Book Review from Circulation:
Electrophysiology for Clinicians

Clinical cardiovascular electrophysiology has rapidly evolved in the past 40 years. Elegant basic and clinical studies have markedly advanced our understanding of electrophysiology in healthy and diseased states. Implantation of sophisticated cardiac devices and ablation of complex cardiac arrhythmias are performed routinely, transforming the care of patients with heart rhythm disorders. In addition, there has been equally rapid evolution with respect to the development of antiarrhythmic agents and novel anticoagulants. However, one should remember that these treatments entered the clinical arena relatively recently, therefore clinical electrophysiology, as practiced today, is a young clinical specialty, and, as such, remains a conundrum to practitioners outside the field. It is exactly to clarify the current state of the art that the book Electrophysiology for Clinicians is a very welcome addition. The authors took on the daunting challenge of writing a concise, yet comprehensive and up-to-date summary of electrophysiological disorders and their management, providing well-reasoned perspectives on when patients should be referred for evaluation by an electrophysiologist. Despite its title, the book's reach will extend beyond practicing clinicians. The allied professional involved in the care of the patient with cardiac arrhythmias will find it a helpful resource that explains the rationale for a variety of treatment modalities. The book will also serve as a useful overview for the general cardiology fellow, medical resident, and medical student in a clinical electrophysiology rotation. Importantly, the simplification required for concision respects both the content's complexity and the reader's intelligence. The book was not meant to be a surface or intracardiac ECG guide, nor a detailed physiological guide for the basic scientist, although a basic scientist interested in gaining insight into clinical electrophysiology practice will find it helpful. The book is clearly organized in 4 parts (Basic Cardiac Electrophysiology, Disorders of Impulse Formation and Propagation, Syncope/Sudden Cardiac Death/Clinical Arrhythmias, and Pacemakers/Defibrillators/Techniques). All chapters are consistently formatted into general principles, mechanisms, clinical history, physical examination, diagnosis, therapy, and cardiology evaluation. Such structure provides a clear flow of information and easy indexing for searching.

Part I (Basic Cardiac Electrophysiology: Chapters 1 and 2) is a major accomplishment of clarity and brevity, reflecting sophisticated authors with detailed knowledge of the field. Chapter 1 manages to describe the basic cellular rules that govern cardiac behavior in <10 pages; the authors are able to provide a pleasant review to more knowledgeable readers and a clear and precise introduction to the beginner. Chapter 2 is a review of antiarrhythmic drugs. It serves both as a road map to build basic knowledge, and also as a quick guide to the clinician at the bedside. It is also a friendly reminder that our drugs are not harmless, highlighting the importance of clinical oversight by the electrophysiologist.

Part II (Disorders of Impulse Formation and Propagation: Chapters 3 and 4) deals with bradyarrhythmias. It has excellent charts and tables, closing the loop from pathophysiology to guidelines regarding indications for pacing. There is 1 error in this section worth noting: The figure intended to demonstrate Mobitz II block is more consistent with Mobitz I block (normal QRS and shortened PR with resumption of conduction); it would have been less equivocal to show Mobitz II block associated with interventricular conduction delay and normal PR interval, the more common findings associated with Mobitz II block.

Part III (Syncope, Sudden Cardiac Death, and Clinical Arrhythmias: chapters 5-10) tackles individual arrhythmias and clinical syndromes. In keeping with the rest of the book, the chapters are well organized, maintaining parallel structure to describe the different arrhythmias and syndromes. Following a succinct and reasonable overview of syncope, there are chapters covering sudden cardiac death, atrial fibrillation, macroreentrant atrial tachyarrhythmias, supraventricular tachycardia, and ventricular arrhythmias. All topics are covered with updated information, albeit absent nuances that would be beyond the scope of this type of compendium.

Part IV (Pacemakers, Defibrillators and Techniques: chapters 11-13) aims to demystify current approaches to device therapy. Chapter 11 explains the pacing mode nomenclature and provides a great overview of pacemaker programming. There is brief mention of physiological pacing, although one could argue that such a powerful and relatively novel therapeutic option deserves a chapter of its own. Chapter 12 explains the state of the art on implantable cardiac defibrillators, describing how implantable cardioverter-defibrillators have evolved significantly from the original shock box. The final chapter contains miscellaneous electrophysiology techniques, including electrophysiology study, cardioversion, signal average ECG, and tilt table testing. Clinical Cardiac Electrophysiology was written by multiple authors from a single institution. As such, the book strictly adheres to a cohesive and coherent narrative. As a drawback, in areas lacking consensus, it leans toward the practice and biases of the institution, on occasion representing those biases as consensus approaches. For instance, the authors advocate for the discontinuation of oral anticoagulation before invasive electrophysiology procedures, which many centers would continue, particularly in procedures where extensive ablation is anticipated in the left heart. There is emphasis regarding the relative safety of cryoablation without acknowledging its relatively higher recurrence rate in comparison with radiofrequency in the treatment of supraventricular tachycardia, reflecting the fact that this center is a well-known advocate for cryoablation as an alternative to radiofrequency. Specific ablation strategies for atrial fibrillation and accessory pathways vary. Therefore, it is not surprising that an attempt to summarize approaches would reflect institutional bias to some degree, but it would be helpful in this context to highlight that fact for the nonelectrophysiologist clinician who may come across a well-reasoned but alternative approach at their own center.

Overall, the book is a concise guide to the clinical understanding and practice of cardiovascular electrophysiology at the start of the 21st century and, as such, represents a welcome summary and reference for the nonelectrophysiologist contending with the complex array of issues and options for their patients with electrophysiological diagnoses, and it provides a helpful overview of the field for allied health professionals and individuals early in their medical training.

Reviewed by:
Daniel D. Correa de Sa, MD

Department of Medicine

University of Vermont College of Medicine

Fletcher Allen Health Care

Burlington, VT

Daniel L. Lustgarten, MD, PhD
Department of Medicine

University of Vermont College of Medicine

Fletcher Allen Health Care

Cardiovascular Research Institute

Burlington, VT
Disclosures:
Dr Lustgarten is a consultant, advisor, and receives research support from Medtronic, and he is a consultant for Biosense Webster. Dr Correa de Sa reports no conflicts.
© 2012 American Heart Association, Inc.

Circulation. 2012; 125: e939-e940 doi: 10.1161/CIRCULATIONAHA.111.077412


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