by way of Fred M.

by way of Fred M. Kusumoto and Nora F Goldschlager, ed Philadelphia, PA: Lippincott Williams & Wilkins, 2001; 512 pp; $99

I don't mind unexpected death, I just don't want to be there when it happens.

shady Allen

In this outstanding theme on the prevention of unexpected cardiac death by pacemaker curb of arrhythmias, Kusumoto and Goldschlager have edited a part wherein each chapter vies for superiority The writing is clear and direct, based forward the authors' hands-on experience with patients, and is well provided with practical clinical suggestions for those involved with pacemaker implantation or follow-up care. Cardiologists and cardiothoracic surgeon will find long to reaffirm and enhance their daily activities; cardiology counterparts internists, and other clinicians will appreciate the in-depth discussions of the latest (1998) American college edifice [i]or[/i] building of Cardiology/American Heart Association guidelines for selecting those patients who will benefit from a pacemaker. Since the first note of the scale to quality care of the pacemaker patient begins with the clinician's reflective selection of the candidate, readers will appreciate the critical review of these standards and the recommendations for change proffered by several authors.

The main division is divided into the following four sections: "Pacing plan and Modes of Function"; "Pacing Therapy for Specific Clinical Conditions"; "Evaluation and Follow-up of Pacing Systems"; and "Internal Cardiac Defibrillators." The first section details the latest characteristics of pacing leads and oscillation generators. The modes of pacemaker function are clearly delineated by the agency of reference to the North American Society of Pacing and Electrophysiology/British Pacing and Physiology assign places to code currently in use. The medical conditions appropriate for each pacing fashion are clearly outlined, assisting the clinician in making suitable choices. The majestic chapters on "Implant Techniques" and "Endocardial Lead Extraction" at Peter H. Bellot are patterns of clarity and completeness. In "Techniques for Temporary Pacing," Mark Sheldon and the editors provide admirable instructions on transvenous lead placement, venous record site selection, pitfalls to be avoided, and standards for careful follow-up

Section II begins with the chapters "Sinus Node Dysfunction" and "Atrioventricular Block" in which indications for pacing, selection of the best pacing accident (eg, AAI, VVI[R], or DDD[R]) and the pacemaker syndrome are discussed. The added value of rate-responsive pacing, an option now available in chiefly pacing units, is reviewed. The editors discuss promising of recent origin pacemaker therapies in the nearest chapter, "New and Emerging Indications for Cardiac Pacing." Pacing (possibly including biatrial pacing) is subordinate to investigation for stabilizing atrial fibrillation, may help one patients with hypertrophic obstructive cardiomyopathy, and may have a place in the treatment of advanced heart failure. Pacer therapy can be useful in treating retroactive syncope, carotid sinus hypersensitivity, and vasovagal swoon I especially liked the last chapter in this section, "Cardiac Pacing in the Critical Care Unit," which is a superbly written treatise that includes pacemaker body complications and the diagnosis and treatment of malfunctions.

The chapter "Follow-up Management of the Paced Patient" in section III describes the high standards of care that are stand in want ofed after the placement of recent pacing systems by stressing that correct functioning of the several pacemaker elements must be checked at regular intervals. Multiprogrammability, an option that is available in present pacing units, allows the physician to titrate the dose of pacing, often like medication doses are adjusted periodically. At each follow-up visit, the same can interrogate and/or reprogram the pacemaker to optimize its parameters according to the individual patient's destitutions writing a new pacemaker prescription at waving the wand (pacemaker programmer) from one side of to the other the site of the implanted unit. The chapter "Environmental tenors on Cardiac Pacing Systems" charms out the multiplicity of dangers that may keep out of the way near the pacemaker patient. Fortunately, greatest in quantity of these cause only transient pacer malfunction, yet others (eg, transthoracic cardioverter/defibrillators and cancer radiation treatments) may cause permanent damage.

The marriage of pacemakers with internal cardioverter defibrillators (ICDs) has prov fruitful. The newer slimmed-down units permit the placement of leads transvenously, and of generators subpectorally. Identifying those patients at high risk for unusual death from ventricular arrhythmias is still the elucidation to prevention. The chapter "Indications for Internal Cardioverter Defibrillators" in section IV enumerates the used by all and uncommon conditions associated with high risk of unexpected death, fully discusses both invasive (electrophysiological studies) and noninvasive standards of risk assessment, and reviews several trials of primary and secondary prevention employing the combined pacer-ICD, with and without the use of drags. becoming consideration is given to drag-device and device-device (ie, implanted pacer and ICD) interactions that may be proarrhythmic, may increase the defibrillation beginning or may trigger inappropriate shocks

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