Preface

The mission of the first two editions of this book was to provide the reader with an approach to interpreting the information provided by ECG and EGM tracings. This mission was achieved through a large number of tracings, teaching by case example rather than providing an encyclopedic record of electrophysiological phenomena and arrhythmias. In addition to having an approach or plan of attack, it is a given that the reader needs to know the EP principles to interpret what is going in. The approach is useless if one does not have the building block foundations of electrophysiology, such as the concept of fusion and reset, normal physiological behavior of the AV node, behavior, and types of accessory pathways. Committing lists of differential diagnosis to memory is invaluable. For example, an SVT with intermittent block to the atrium immediately excludes atrioventricular re-entry and leaves us with a short list that includes junctional tachycardia, AV node re-entry, nodoventricular/nodofascicular re-entry, and narrow QRS VT mimicking SVT. We try to teach these principles and provide these lists as they come up in individual cases.

The concepts and tracings in these two editions are timeless, and we didn’t feel compelled to make great changes. However, we did add a couple of chapters with specific emphases.

Chapter 3 is intended to highlight the utility of the ECG and show how the same physiology principles guide the interpretation of each. The ECG is presented first, followed by the backup intracardiac tracings. In many cases, it will become evident that the ECG already provided the essential diagnosis.

Chapter 8 recognizes that many of our readers will have to write certifying exams of some sort and will use a book such as ours for practice and guidance. We thus add multiple choice questions and expand on strategies to get through the exam.