Preface

Twenty-five years ago, Drs. Prystowsky and Klein authored the first edition of this textbook. Our purpose was to “write a comprehensive textbook on an integrated approach to cardiac arrhythmias for individuals without a background in clinical electrophysiology.” While we hoped clinical electrophysiologists would find our book useful, our intent was to educate the broader field of clinicians, for example, medical students, house staff, primary care physicians, cardiologists, and nurses, on the diagnosis and treatment of patients with cardiac arrhythmias. Thousands of copies of the book were sold, and we hope those readers found it useful. We received much feedback from our colleagues and trainees over the years and discussed with each other some alterations to consider when we wrote a second edition. While other textbooks on cardiac arrhythmias are available, we felt there remained a void in providing our practical application of electrophysiological principles and electrocardiographic correlations to the broader community involved in caring for patients as well as the clinical electrophysiologist. This motivated us to pursue a second edition of our book. We welcome our new co-author, Dr. James Daubert, also a Duke-trained electrophysiology fellow, and long-standing friend and colleague.

There has been a sea change in the last 25 years to our therapy of cardiac arrhythmias. Surgery to cure arrhythmias is nearly extinct, and new antiarrhythmic drug development has been stagnant. At the same time, there have been remarkable advances in catheter ablation technology and its application to treat a wide variety of cardiac arrhythmias, as well as development of newer implantable cardiac electrical devices and indications for their use. The content of our second edition reflects these changes in our field, and we have deleted specific chapters on arrhythmias in acute myocardial infarction, pharmacologic therapy, operative therapy of arrhythmias, and noninvasive methods. Important information on drug therapy and noninvasive methods is covered in other chapters. Further, we have added new chapters on atrial fibrillation, catheter ablation of supraventricular tachycardia, catheter ablation of ventricular tachycardia, and provide a major update in the chapters on sudden cardiac death and device therapy. Many new figures and information have been added to the existing chapters. To allow for easier reading, there is some deliberate overlap of information between various chapters. Key references of classic and up-to-date articles are provided for each chapter.

Like the first edition, this book represents our personal approach to patients with cardiac arrhythmias. Nonetheless, it would be unrealistic to expect 3 electrophysiologists to have entirely uniform approaches to diagnosis and therapy. Hence, the primary author’s views in individual chapters prevailed when there were minor differences in approach. Each of us reviewed all the chapters and made recommendations for change. In the end, we did not feel there were any substantial differences in our approach to patient care and were comfortable in signing off on the total content.

The book is divided into 4 parts. Part I is Basic Electrocardiographic Observations and Clinical Electrophysiologic Correlates. There are in-depth discussions of cardiac conduction with major additions on the effects of alterations in autonomic tone, effects of premature atrial and ventricular ectopy on conduction and automaticity, concealed conduction and apparent paradoxical conduction, bundle branch block, and mechanisms of tachycardia. Part II focuses on specific arrhythmias. It begins with an in-depth chapter on a clinical classification of supraventricular tachycardia and includes chapters on the preexcitation syndrome (Wolff-Parkinson-White), ventricular tachycardia, atrial fibrillation, and bradycardia. Diagnostic information from patient history, physical examination, and laboratory tests is given, as well as an approach to therapy for each arrhythmia. Part III includes chapters on common clinical presentations of arrhythmias. An approach is given for patients who are asymptomatic but have electrocardiographic abnormalities, and for those who present with a narrow QRS tachycardia, wide QRS tachycardia, syncope, dizziness, palpitations, or who have survived a cardiac arrest. Part IV consists of chapters on diagnostic techniques and therapeutic modalities. Included are methods of electrophysiologic testing and diagnostic pacing maneuvers, catheter ablation of supraventricular tachycardia, catheter ablation of ventricular tachycardia, and device therapy.

Acknowledgements: Dr. Prystowsky thanks Mrs. Jane Gilmore, CMI, for her outstanding artwork.