Fighting Sudden Cardiac Death: A Worldwide Challenge reviews the background of sudden cardiac death (SCD) in light of new advances in genetics, mechanisms of therapy, and prevention, thus providing the reader with a more unified view of SCD, a better understanding of the pathological mechanisms of SCD, and the tools needed to identify the appropriate treatment for patients at risk for a primary event.
Its 50 chapters incorporate expert findings on a wide variety of relevant subjects, ranging from cell to examination, from idiopathic arrhythmias and SCD in athletes to arrhythmogenic heart failure, from long QT syndrome to ventricular dysplasia, from prehospital resuscitation to very sophisticated implantable devices. In-depth discussions on the background, therapy and prevention of SCD serve to increase and improve the tools available to battle this "serial killer."
Cardiologists, electrophysiologists, and internists, both in clinical practice and in the laboratory, will find a great deal of valuable information in this book.
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In their preface, the editors state that it was their intention to analyze the problem of sudden death from cardiac causes from a variety of perspectives, from its pathophysiology to the results of randomized clinical trials. Indeed, the book covers a wide array of topics. For instance, the initial chapters cover epidemiology and mechanisms, with discussions of the autonomic nervous system, genetics, after-depolarizations, and regional differences in the electrophysiology of ventricular cells in relation to the development of ventricular fibrillation. Other chapters cover sudden death and the athlete, arrhythmogenic right ventricular dysplasia, repolarization syndromes (such as the long-QT syndrome and the Brugada syndrome), risk stratification in patients with and without ischemic heart disease, and treatment, primarily the use of implantable cardioverter-defibrillators. The role of medical therapy in the prevention of sudden death from cardiac causes is also covered, with a review of the use of amiodarone, beta-blockers, and angiotensin-converting-enzyme inhibitors.
It is a real advantage to be able to review easily topics as diverse as idiopathic ventricular fibrillation and the problem of sudden death in hypertrophic cardiomyopathy, mitral-valve prolapse, and repaired congenital heart disease, all in one book. In addition, the discussions in the book are current and include recent information from basic research as well as clinical trials; the references, for the most part, cover publications through 1999.
Some topics in the book are of questionable relevance. For instance, the development of evidence-based guidelines in general is discussed, and the telephone numbers for emergency medical services in the various countries of Europe are provided. On the other hand, the book covers many timely topics of interest to those who are dedicated to reducing the incidence of sudden death from cardiac causes. I found the chapters on arrhythmogenic right ventricular dysplasia, the Brugada syndrome, and the long-QT syndrome particularly informative. For each of these disorders, genetic considerations, ion-channel defects, mechanisms of arrhythmias, and recommendations for treatment are covered in detail, and observations in series of patients are provided.
The book will appeal primarily to physicians who specialize in electrophysiology and to cardiologists who have a particular interest in the prevention of sudden death. Internists and allied health professionals will probably find that the book contains more detail, particularly at the level of basic research, than is essential for general patient care, unless they have a specific interest in a particular topic.
Anne B. Curtis, M.D.
Copyright © 2001 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
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