Foundations of Cardiac Arrhythmias (Fundamental and Clinical Cardiology)

861 Pages·2000·95.63 MB·English

by  Peter M. Spooner

Foundations of
Cardiac Arrhythmias
FUNDAMENTAL AND CLINICAL, CARDIOLOGY
Editor-in-Chief
Samuel Z. Goldhaber, M.D.
Harvard MedicalS chool
and Brigham and Women'S Hospital
Boston, Massachusetts
Associate Editor, Europe
Henri Bounameaux, M.D.
University Hospital of Geneva
Geneva, Switzerland
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2. Cardiotonic Drugs: A Clinical Review, Second Edition, Revised and Expanded,
edited by Carl V. Leier
3. Complications of Coronary Angioplasty, editedb yA lexanderJ .R .B lack, H.
Vemon Anderson, and Stephen G. Ellis
4. Unstable Angina, edited by John D. Rutherford
5. Beta-Blockers and Cardiac Arrhythmias, edited by PrakashC . Deedwania
6. Exercise and the Heart in Health and Disease, edited by Roy J. Shephard and
Henry S. Miller, Jr.
7. Cardiopulmonary Physiology in Critical Care, edited by StevenM . Scharf
8. Atherosclerotic Cardiovascular Disease, Hemostasis, and Endothelial Function,
edited by Robert Boyer Francis, Jr.
9. Coronary Heart Disease Prevention, edited by FrankG . Yanowitz
IO. Thrombolysis and Adjunctive Therapy for Acute Myocardial Infarction, edited by
Eric R. Bates
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edited by RoberAt . Kloner and Karin Ptzyklenk
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13. Silent Myocardial Ischemia and Infarction: Third Edition, Peter F. Cohn
14. Congestive Cardiac failure: Pathophysiology and Treatment, edited by David B.
Bamett, Hubert Pouleur, and GarSy . Francis
15. Heart Failure: Basic Science and Clinical Aspects, edited by Judith K. Gwathmey,
G. Maurice Briggs, and Paul D. Allen
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Adjunctive Therapy, edited by Burton E. Sobel and Desire Collen
17. Cardiovascular Disease in the Elderly Patient, edited by Donald D. Tresch and
Wilbert S. Aronow
18. Systemic Cardiac Embolism, edited by Michael D. Ezekowitz
19. Low-Molecular-Weight Heparins in Prophylaxis and Therapy of Thromboembolic
Diseases, edited by Henri Bounameaux
20. Valvular Heart Diseases, edited by Muayed AI Zaibag and Carlos MG. .D uran
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22. Individualized Therapy of Hypertension, editedb yN orman M. Kaplana ndC .
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23. Atlas of Coronary Balloon Angioplasty, Bernhard Meier and Vivek K. Mehan
24. Lowering Cholesterol in High-Risk Individuals and Populations, edited by Basil M.
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25. Interventional Cardiology:N ew Techniques and Strategies for Diagnosis and
Treatment, edited by Christopher J. White and Stephen Ramee
26. Molecular Genetics and Gene Therapy of Cardiovascular Diseases, edited by
Stephen C. Mockrin
27. The Pericardium: A Comprehensive Textbook, David H. Spodick
28. Coronary Restenosis: From Genetics to Therapeutics, editedb yG iora Z.
Feuerstein
29. The Endothelium in Clinical Practice: Source and Target of Novel Therapies,
edited by Gabor M. Rubanyi and Victor J. Dzau
30. Molecular Biology of Cardiovascular Disease, edited by Andrew R. Marks and
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32. Intravascular Ultrasound Imaging in Coronary Artery Disease, edited by Robert J.
Siege1
33. Saphenous Vein Bypass Graff Disease, edited by Eric R. Bates and David R.
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34. Exercise and the Hearti n Health and Disease: Second Edition, Revised and
Expanded, edited by RoyJ . Shephard and HenryS . Miller, Jr.
35. Cardiovascular Drug Development: Protocol Design and Methodology, edited by
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McCall Comoss
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41. Foundations of Cardiac Arrhythmias: Basic Concepts and Clinical Approaches,
edited by PeterM . Spooner and Michael R. Rosen
ADDITIONAL VOLUMES IN PREPARATION
Cardiovascular Plaque Rupture, edited by DavidL . Brown
Interpreting Electrocardiograms: Using Basic Principles and Vector Concepts,
by J. Willis Hurst
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Foundations of
Cardiac Arrhythmias
~~ ~
Basic Concepts and Clinical Approaches
edited by
Peter M. Spooner
National Institutes of Health
Bethesda, Maryland
Michael R. Rosen
Columbia University
New York,N ew York
m
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Series Introduction
Marcel Dekker, Inc., has focused on the development of various series of beautifully pro-
duced books in different brancheso f medicine. These series have facilitated the integration
of rapidly advancing information for both the clinical specialist and the researcher.
My goal as editor-in-chief of the Fundamental and Clinical Cardiology series is to
assemble the talents of world-renowned authorities to discuss virtually every areao f car-
diovascular medicine. In Foundations of Cardiac Arrhythmias, Peter M. Spooner and
Michael R. Rosen have prepared a much-needed and timely book. Future contributions to
this series will include bookso n molecular biology, interventional cardiologya, nd clinical
management of coronary artery disease.
Samuel Z. Goldhaber
iii
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Foreword
Cardiac arrhythmias constitute a major clinical probltehmat presents itself in many ways,
with the worst manifestation being sudden death. The developmeonft the electrocardio-
gram by Einthoven nearly 100 years ago provided the first meansu sf otor view theirc om-
plexity and diversity.Y et, despite nearly a century of clinical observationo f arrhythmias, it
is onlyi n recent years that we have witnessed significant progreisns their treatment. Thus,
it was interesting to note that oonf et he earliest discussions on the cardioversoiof ne ctopic
tachycardias, presented by Dr. Bernard Lown at the 1972 meeting of the Association of
American Physicians, notedth at “for the past 45 years, cardiac arrhythmiah as been tradi-
tionally terminated by means of drugs, particularly quinidine.” Although the utilityo f that
approach remains problematic for most arrhythmias, much has changed and remarkable
therapies have becomea vailable.
In his landmark book Heart Diseuse, published in 1931, Dr. Paul Dudley White de-
voted several pages to a consideratioonf cardiac arrhythmias.H e then wrote:
Notching or slurring of any of the componentso f the QRS complex may occur in slight degree
normally or when there is considerable axis deviation in either direction, but it becomes
marked only with ventricular premature beats, ventricular tachycardia, or intra-ventricular
block.
Later in Dr. White’s book, there are several chapters discussing abnormal cardiac
rhythms due to unusual excitability and stimulation. Then a section follows on sudden
death, which at the time was described as “an abrupt standstillo f the heart, as yet unex-
plained.”
That was 193 1! As we now enter the next millennium, the scientific community
brings with it an enormous trove of recent discoveries andm uch better understanding of
V