John A. Kastor
603 pp. Philadelphia: Saunders; 2000. $130.00. ISBN 0-7216-76472
From fairest creatures we desire increase,
That thereby beauty’s rose might never die,
But as the riper should by time decease,
His tender heir might bear his memory
— William Shakespeare, Sonnet I
Population aging and improvements in patient care have led to an increase in the number of subjects diagnosed as having supraventricular or ventricular arrhythmias. This means that physicians encounter these diseases increasingly frequently and need to keep up with the ever-changing pathophysiological, clinical, and therapeutic information regarding rhythm disturbances. But is a book on arrhythmias the best way of satisfying this need? In the Internet era, information is supposed to reach users in almost-real time, and so books risk being inadequate; however, even those of us who are particularly fond of net surfing will agree that a good book is still a fundamental point of reference.
This is the scenario in which Arrhythmias appears. The fact that this is the second edition of the book gives it the privilege of tradition but also leads to expectations. In his preface, Kastor states that the book has not been addressed to clinical electrophysiologists, and I agree that the people who will get most out of the book are the nonspecialists in this field. However, its 600-plus pages contain a lot of information (particularly those of epidemiological and historical interest) that even electrophysiologists will find intellectually stimulating.
Kastor is a highly regarded scientist, but the opening of the book bears witness to his erudition. The first 3 chapters will evoke in educated readers the lines of Shakespeare’s first sonnet. In this very elegant historical section, it is possible to recognize the author’s profound love and gratitude for the pioneers of clinical electrophysiology and, what is particularly important, his awareness that every improvement has its roots in the results achieved by previous generations. This historical approach is maintained throughout the book, thus demonstrating the extensive and careful research underlying the author’s selection of his sources.
The task of dealing with arrhythmias is not easy, particularly when the audience is not familiar with them. Its simple (and anything but banal) structure is one of the key points that will make the book successful. The descriptions of electrophysiological mechanisms greatly benefit from this approach, and even the arrhythmias that are generally considered difficult to understand, such as paroxysmal supraventricular tachycardias and preexcitation syndromes, are clearly explained. This is also made possible by the extensive use of diagrams and figures, which make the mechanisms described in the text immediately comprehensible. The book is not lacking in appropriate electrocardiographic examples of arrhythmias and, despite the fact that the number of electrophysiological recordings has been kept to a minimum, they have been chosen so carefully that learning is really improved. Putting it another way, iconography significantly increases the teaching value of the book.
A second important point is that the arrhythmias are discussed in their various clinical contest, thus revealing the author’s willingness to offer a practical instrument for better understanding the relevance and treatment of arrhythmias in each individual patient. Arrhythmias are seen here as specialists in internal medicine would like to see them. Cardiac and noncardiac causes, precipitating events, and clinical implications all receive due attention. One example is the broad dissertation on emboli and stroke risk in patients with atrial fibrillation, a topic that even cardiologists have tended to disregard. The practical role of the book is also strengthened by its wide use of detailed tables of diagnostic criteria laid out in such a way as to provide a practical instrument for differential diagnosis.
The third point is the ability of the author to blend simplicity and the latest information coming from arrhythmia research. Kastor keeps his promise of offering a book aimed at answering the everyday clinical problems facing clinicians, nurses, and the other healthcare workers involved in the care of arrhythmic patients and, simultaneously, takes the opportunity to present an updated text that is rich in genetic-related information, modern diagnostic criteria, and therapeutic options. Once again, it is the structure of the book that prevents this information from confusing less-expert readers. In particular, a key role is played by the bright use of footnotes, which can be easily skipped if you are not interested in a particular point but which, together with the impressive list of bibliographical references, provide a precious stimulus for further study.
This book should be of interest to all students and clinicians (working in the field of cardiology or not) who would like to know more about arrhythmias. Kastor skilfully maintains a difficult balance between accurate scientific information and the need to offer a practical and useful guide for treating patients; the result is a book that physicians would rather have on their desks than in their bookshelves.