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Clinical Arrhythmology PDF

Clinical Arrhythmology PDF

Clinical Arrhythmology PDF



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Preface

First, I would like to explain why I have written this book. I am a clinical cardiologist who has been especially dedicated to teaching and research in electrocardiography as well as in clinical and non-invasive aspects of Arrhythmias and sudden death (SD). Looking back on my life, I have had the opportunity to contemplate how arrhythmology has changed in the last 50 years and become a well defined subspecialty. Currently, arrhythmologists not only need important training as interventionist electrophysiologists, but also a wide knowledge of the epidemiological, clinical, electrocardiographic and genetic aspects of all arrhythmias. My main interest in writing this book is to make available to the clinical cardiologist, or trainee in cardiology, internist or general practitioner interested in this topic, the anatomical and electrophysiological aspects necessary for understanding the mechanisms of arrhythmias and the bases to diagnose and treat them with precision. I do not, however, describe in detail the technical aspects of each diagnostic and therapeutic procedure used today, nor do I discuss the molecular and genetic aspects of cardiac arrhythmias in depth. The reader may find an adequate bibliography for all of this in the text. However, I believe that this book fills a gap. Currently, most arrhythmology books extensively present those aspects related to treatment through invasive methods rather than examine how the diagnosis of an arrhythmia is reached through history taking and careful surface electrocardiography. At the same time, this book also presents a practical, up-to-date focus on prognosis and therapeutic decision making in all types of arrhythmias, including the prevention of SD.
The book is divided into three parts. In the first part, the concept, classification and clinical progress of arrhythmias is presented, with emphasis on its relation to sudden death, as well as the most interesting information still relevant today on the great utility of anamnesis and the physical exam in their diagnosis. Next, the characteristics of each type of cardiac cell are described from an ultrastructural, ionic and electrophysical point of view. Lastly, the most important electrophysiological mechanisms that explain cardiac arrhythmias are discussed.
The second part describes the key elements used to carry out an electrocardiographic diagnosis of the various active and passive arrhythmias, the clinical and prognostic implications and the best method of treatment, explained in a practical way. The current utility of anti-arrhythmic agents and the various techniques (cardioversion and ablation) and implantable devices (pacemakers and defibrillators) available is discussed. They are very useful in the treatment of arrhythmias and the prevention of SD. Finally, in Chapter 7 I describe how to carry out the analytical study and differential diagnosis of different arrhythmias.
The third part deals with the most frequent arrhythmological syndromes, including pre-excitation and channelopathies, as well as other electrocardiographic patterns suggestive of a risk of arrhythmia or sudden death. The most frequent arrhythmias and the markers of SD in different arrhythmias and different situations are also described.
Throughout the book, emphasis is placed on the importance of surface electrocardiography as the basic technique to diagnose arrhythmias at a clinical physician’s level. However, in the Appendix there is a review of other complementary techniques, which at times are very useful in reaching the correct diagnosis or carrying out the most adequate treatment. The reader will find more information about these techniques in the recommended bibliography (see p. xii). Additionally, the Appendix includes an explanation of the basic concepts of sensitivity, specificity and predictive value necessary for the correct evaluation of the different diagnostic electrographic criteria. I also explain the recommendations for both treatment and the application of the various diagnostic tests mentioned in the Scientific Societies guidelines. The physician must of course take these guidelines into consideration but has to bear in mind the individual characteristics of each case, as well as his own personal experience, in order to reach the most accurate diagnosis and offer his patients the best therapeutic option for each arrhythmia. This is the ideal way to proceed, since the guidelines sometimes have not introduced the latest developments and do not contemplate that all the best approaches of management may not be feasible in developing countries. This is what I think has to be considered at all times.


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