James C. Eisenach, M.D., Editor.

By John L. Atlee. Philadelphia, WB Saunders and Company, 1996. Pages: 477. Price: $60.00.

This book is a new edition from a very prolific author/researcher who has authored two editions of Perioperative Cardiac Arrhythmias. The author states in his preface that his previous book was designed to be a "complete source of information pertaining to perioperative cardiac arrhythmias, including their mechanism, diagnosis, prevention and management," whereas this new book is "a more succinct work focusing almost exclusively on the practical aspects of diagnosis and management."

A brief overview reveals a very attractive, relatively compact book with ten chapters. The tables and figures are generally very clear, sharp, and easy to understand. Especially outstanding are the schematic diagrams of arrhythmias, QRS morphology, and anatomy that are superior to those in most cardiac arrhythmia text books available. However, some of the figures of electrocardiograms and arrhythmias from patients were poorly reproduced by the publisher. Each chapter begins with a table of abbreviations and ends with a limited number of references.

Chapter 1 provides a brief overview of incidence and outcomes related to problems associated with arrhythmias and pacemakers during the perioperative period. Chapter 2 covers the anatomy of the conduction system and related mechanisms for cardiac arrhythmias. This mechanistic information, which can be overwhelming to many perioperative physicians, is covered in a relatively simple, direct style that is easily understandable. This chapter establishes a level of basic knowledge necessary for management decisions and is one of the better written chapters in the book.

Chapter 3 basically lists all potential causes of arrhythmias, from autonomic imbalance and drug toxicity to specific patient conditions associated with arrhythmias, such as amyloidosis and mitral valve prolapse syndrome. This chapter may have benefitted from a more complete discussion of the more common causes of arrhythmias while listing the more esoteric causes in tabular form.

Chapter 4 nicely covers basic electrocardiography including how to obtain an electrocardiography and normal P-QRS-T wave interpretation. Numerous examples of variations of the standard electrocardiogram, including accessory pathways, aberrant conduction, and fusion beats, are presented. Chapter 5, structurally similar to Chapter 3, lists all antiarrhythmics and includes the pharmacokinetics, adverse effects, and administration information for each drug.

Chapters 6-8 cover cardiac pacemakers, temporary pacing, electrical cardioversion, and automatic implantable cardioverter defibrillators (AICDs). The strength of these chapters is in chapter 7, which addresses temporary and emergency cardiac pacing. This is a comprehensive discussion and a highlight of the book. Chapter 8 discusses practical aspects of perioperative management of patients with pacemakers and AICDs. This chapter should have included important information on management of the newer rate-adaptable pacemakers that may change heart rate with changes in chest wall impedance (e.g., hyperventilation), dP/dt of the right ventricle, mixed venous oxygen saturation, among others and may have important adverse physiologic consequences during the perioperative period.

Chapters 9 and 10 complete the book by addressing diagnosis and management of supraventricular and ventricular arrhythmias. The quality of the reproduced electrocardiograms could have been improved, although most are interpretable. The sections on accessory pathways have excellent illustrations and is completely covered. In general, most of the necessary information is covered in these chapters, but at times, it is difficult to retrieve. For example, the main diagnostic criteria of wide QRS tachycardia can be extracted from the text, but a table would have made it easier for the reader to obtain this information.

In summary, Arrhythmias and Pacemakers covers the essentials of modern perioperative care of patients with arrhythmias and pacemakers. It is brief and concise, with numerous illustrations and only the most important references. I believe this book is superior to the author's previous works, especially to most busy practicing anesthesiologists and other physicians who want a text from which they can quickly obtain information concerning perioperative problems related to the day-to-day management of patients with arrhythmias and pacemakers.

Roger L. Royster, M.D., Professor and Vice Chairman Department of Anesthesia, The Bowman Gray School of Medicine of Wake Forest University, Medical Center Boulevard, Winston-Salem, North Carolina 27157-1009.