Cardiac Electrophysiology: From Cell to Bedside, Fourth Edition

Douglas P. Zipes, Jose Jalife, eds.
1115 pp. Philadelphia, Pa: W.B. Saunders; 2004. $259.00; ISBN 0721603238

This is the fourth edition of a book that has become the reference source for advanced cardiac electrophysiology. The first edition was published in 1990 with the intention of bridging the gap between investigators of basic cardiac electrophysiology and clinicians treating cardiac arrhythmias. At that time, the book had 109 chapters, 221 authors, and 1034 pages. The current edition has 120 chapters, 245 authors, and 1144 pages. It is interesting to note that only 48 (22%) of the authors from the first edition survived to the fourth (I am one of the 78% who did not). This illustrates that in cardiology not only does 50% of our knowledge change every 5 years but so do the people involved in these changes.

I could not resist looking over all 4 editions at once because this so beautifully illustrates what has happened during the last 15 years in cardiac electrophysiology. In general, I noticed a trend toward including more basic and less practical clinical information. For example, although conduction disturbances and tachyarrhythmias are discussed in many of the chapters, it is hard to find 12-lead ECGs of clinical arrhythmias. Most of the information and illustrations concern advanced intracardiac mapping and stimulation techniques and complex catheter ablative procedures. Apparently the editors decided that our young colleagues should obtain knowledge of the characteristics of cardiac arrhythmias on the surface ECG elsewhere. Perhaps they felt that not much new information has been uncovered in that area.

It is interesting to note the progress that has been made in our understanding of cardiac ion channel function and how this can be manipulated by pharmacological interventions. As shown in the book we are still, however, wrestling with mechanisms of arrhythmias, especially in situations such as heart failure, in which many different mechanisms play a role. We are also in the dark about possible arrhythmic consequences of cell transplantation (stem cells and myoblasts) to cardiac areas where cells are lost. Much progress has been made in the molecular and clinical genetics of cardiac arrhythmias, with consequences for decision making about therapy, but we are still far from being able to correct the responsible genetic abnormality. What remains disappointing is our limited ability to identify the patient at risk for sudden death outside the hospital. Only ≈10% of those patients can be recognized as being at high risk before the event. This low percentage stresses the need to develop strategies to identify those people much more accurately to be able to protect them. Also, the success rate of resuscitative efforts in cardiac arrest outside the hospital needs to be improved.

In this new edition, hesitation is expressed about the value of currently available antiarrhythmic drugs—even the value of amiodarone is questioned. There seems to be not much activity in the development of antiarrhythmic drugs. Consequently, the use of the implantable defibrillator is growing and taking a big bite out of health budgets. Areas of interest are shifting. In contrast to 14 years ago, atrial fibrillation and heart failure are now featured prominently in this text, both with regard to their mechanisms and the use of newer therapeutic modalities such as catheter ablation for atrial fibrillation and resynchronization therapy for heart failure.

The editors and the authors must be congratulated on this new edition. This book is an indispensable reference source for anyone interested in having a better understanding of cardiac electrophysiology. It certainly demonstrates that the saying “never repeat a successful experiment” does not apply to Cardiac Electrophysiology: From Cell to Bedside.