In terms of cost-effectiveness, there is no doubt that the 12-lead electrocardiogram wins hands down, but there is also no doubt that the efficacy and usefulness of this diagnostic test greatly depend on the knowledge of the person interpreting the results. Therefore, books that help to establish and divulge electrocardiographic knowledge should be given a particularly warm welcome. Among these, “Electrocardiografía clínica” [Clinical electrocardiography] by Professor Antoni Bayés de Luna is an outstanding contribution. This well-known book is now in its seventh edition in Spanish.
My first personal impression is that the most remarkable qualities of this book are the amount, quality, and clarity of the figures and its up-to-date content, including knowledge acquired in recent years. It is nonetheless surprising that a tool that has been in use for over 100 years can still be the object of research and that new information can still be gained about it—an aspect magnificently captured by Professor Bayés in this new edition.
Particularly striking are the chapters that describe a normal electrocardiogram, because, rather than reciting lists of data and features, they concentrate more on the need to understand the root of the problem, teaching readers to reason on the basis of anatomical and vectorial concepts in order to establish what is normal.
These chapters are followed by others that describe abnormal anatomical or electrical patterns of the heart chambers, which are written in an orderly and schematic manner, listing the multiple findings that have been identified and reported over the years.
The section on cardiac arrhythmias (chapters 14 to 18) comprises an interesting understanding of the mechanics of these disorders that makes the reader aware of the complexity of the different abnormalities that can lead to heart rhythm disorders, and includes an interesting classification of these abnormalities that serves as a framework through which readers can organize their knowledge. This is followed by an individual description of each kind of cardiac arrhythmia, with separate chapters on supraventricular and ventricular arrhythmias and bradycardia, and includes aspects on the interpretation of tracings in patients with a pacemaker. Finally, it develops an original “step-by-step” approach for a practical diagnosis of cardiac arrhythmias.
One of the most outstanding features of this book is the fifth part, which includes a series of chapters under the generic heading of “Utilidad clínica de la electrocardiografía” [Clinical usefulness of electrocardiography]. In these chapters, Professor Bayés details his clinical-electrocardiographic vision of cardiology, placing electrocardiograms in the context of each different kind of heart disease. The chapter “La electrocardiografía en los diferentes contextos clínicos de cardiopatía isquémica” [Electrocardiography in the different clinical contexts of ischemic heart disease] clearly describes the enormous problem posed on a daily basis by patients with coronary diseases and their electrocardiographic findings. The chapter on hereditary heart diseases, “Cardiopatías hereditarias”, also addresses highly current and controversial issues in a series of situations that cause great concern among doctors and patients.
Overall, this is a real masterpiece of electrocardiographic knowledge, in a tidier and more-up-to-date format than its previous editions. It includes recent knowledge and will undoubtedly become part of the compulsory reading list for all students of electrocardiography, both clinical cardiologists and distinct specialists who are faced with cardiovascular problems (physicians working in emergency rooms, intensive care units, internal medicine, etc.) and particularly for doctors who are training to specialize in one of these areas. I think that we should all be grateful to Professor Bayés for his dedicated efforts to helping us understand and use electrocardiograms in our daily work through this magnificent book.