Enormous change has occurred in our specialty since the publication of the first edition of Clinical Electrophysiology Review. Diverse energy sources are in development or common use with robotic and magnetic guidance systems to pinpoint the ablation target. We use sophisticated mapping systems with anatomically true graphics online and nonfluoroscopic visualization of our catheters. Online intracardiac ultrasound has become a routine tool in many laboratories. The ablation of atrial fibrillation has become commonplace and is the most common ablation procedure in many laboratories. The ablation of VT has become routine and the pericardial space is frequently entered to access the epicardium.
Despite this tremendous progress, the need to preserve and indeed to cultivate our skills in electrocardiographic and electrophysiologic reasoning and diagnosis remains. There is an increasing emphasis on the technical aspects of electrophysiology in our teaching centers, and generations of young electrophysiologists may not acquire the skills to decipher a complex arrhythmia puzzle. These cases, when they appear, must be dissected in great detail and the learning points must be thoroughly examined. It is in this spirit that we have produced the second edition of this book.
While new cases have been added and others refreshed, those familiar with the first edition will not see a profound change in emphasis. Indeed, the electrocardiographic and electrophysiologic problem-solving skills required to master these arrhythmias have not changed for a long time and are unlikely to change substantively in the future. There is no attempt to include every bizarre case that we see or to provide encyclopedic coverage of every issue. Rather, we emphasize an organized approach based on making observations, "framing" the problem, and testing each "hypothesis" to explain the observations. We have added several ECG examples because ultimately the ECG and intracardiac tracings are on a continuum and require similar approaches and skills. We discourage a strict pattern recognition approach to the ECG in favor of an electrophysiologic approach.
We hope that this edition will serve you well.
George J. Klein, MD
Eric N. Prystowsky, MD