Edited by Douglas P. Zipes, MD and Michel
Haïssaguerre, MD. Armonk, New York: Futura
Publishing Company, Inc., 2002; 464 pages,
228 figures, 15 tables, 98 dollars. ISBN: 0-87993-498-2.
The book brings together in chapter form the papers presented at a symposium on catheter ablation that was held in Burdeos in May, 2001. It consists of 19 chapters, all written by authors and study groups whose work has contributed over the years to the body of knowledge concerning the mechanisms and development of techniques for arrhythmia ablation.
The initial chapters (1 to 4) are miscellaneous in nature; the first chapter describes the findings of studies carried out using optical mapping in experimental situations for the understanding of normal nodal physiology and the distinct types of re-entrance, as well as ventricular myocardial re-entrance. In the following chapter, a method is proposed for performing either minimum or indispensable electrophysiological studies before performing ablation, based on only 2 catheters. Chapter 3 describes the various mapping techniques (the classic method as well as those developed recently) and the indication for each of them according to the type of arrhythmia. The new techniques (including basket catheters, electroanatomic mapping, intracardiac echography, etc.) are described quite superficially, so that the information provided is fairly limited. Nevertheless, chapter 4 is particularly interesting as Dr. D.E. Haines describes the physiopathology and the characteristics of the lesions produced by radiofrequency, depending on the type of catheter used and including the lesions produced by the new energy modalities as applied to ablation.
Chapters 5 to 18 review the state of the art radiofrequency ablation of atrial arrhythmias, tachycardia by intranodal re-entrance, the accessory pathways, and ventricular arrhythmias.
Ablation of atrial fibrillation is divided into 2 chapters. In chapter 5, Dr. M. Haïssaguerre deals with the ablation of the foci that trigger atrial fibrillation and describes the results of his selective ablation technique. In the following chapter, Dr. D.L. Packer provides an exhaustive review of linear ablation in the treatment of atrial fibrillation, describing the technique and the results of the various methods proposed as of the date. Logically, we do not find a reference to the interesting publications that have appeared in the second half of 2001 and in 2002 with regard to this material.
The chapters referring to the rest of the atrial tachyarrhythmias are very well organized into 4 different chapters (ablation of typical flutter, ablation of atypical flutter of the right atrium, ablation of atypical flutter of the left atrium and ablation of focal atrial tachycardia, chapters 7 through 10). These are concise chapters that clearly explain the mechanisms of the arrhythmias, as well as the technique and the results of the type of ablation. The chapter on atypical flutter of the left atrium, a subject on which there is still little knowledge, is basically based on the limited experience of the authors (from Dr. M. Haïssaguerre´s group), offering, nonetheless, details and practice aspects that could be useful for laboratories who are beginning to study this type of arrhythmias.
In chapter 13, Dr. Jackman offers a very interesting and up-to-date review of atypical intranodal re-entrance tachycardia, its mechanisms and ablation peculiarities. Ablation of the accessory pathways is divided into 3 different chapters (14 to 16) according to location. The 3 chapters are interesting, and provide illustrative figures, without being limited to the description of the ablation procedures, as they also provide embriological, anatomical, and electrophysiological explanations of the various types of accessory pathways. Chapter 16 concerns the posteroseptal and posterior left epicardial pathways differentiated by their iconography, with illustrative anatomical drawings, radiology images, and angiography images.
The theme of the ablation of ventricular tachycardia is developed in chapters 17 and 18, and of note the ablation of re-entrance branch-to-branch tachycardia has been grouped together in the same chapter with idiopathic ventricular tachycardia, and it is described in a way that is perhaps too superficial. The chapter on the ablation of ventricular tachycardia associated with structural heart disease (Dr. W.G. Stevenson) stands out because of the clarity of his diagrams, as well as his clinical focus.
In the last chapter, the authors (Drs. H. Kottkamp and. Hindriks) discuss what the immediate future could bring with regard to catheter ablation. They review the new mapping techniques again and their application to arrhythmias, treatment of which still presents an electrophysiological challenge, fundamentally atrial fibrillation and post myocardial infarct ventricular tachycardia.
The iconography is generally quite good, but nonetheless in many of the chapters CARTO figures are included that are reproduced in black and white, which makes their comprehension and interpretation difficult. Some of these figures (but not all) are reproduced in color in and appendix.
Taken together, this is an interesting book and it should be recommended as a part of the electrophysiology laboratory library, especially if they have electrophysiologists in training. Given the conciseness of its central chapters, it would also be useful for cardiology residents during their rotation on the arrhythmia unit. Its small format also makes it very manageable.