Preface

A few years ago, I, Antoni Bayés de Luna, wrote a book on Clinical Arrhythmology. The title was chosen to express that my aim was to share with the reader my point of view, as a clinical cardiologist, of what are the most important concepts related to arrhythmias, including genetic, epidemiological, and diagnostic aspects that may be useful to treat these patients. My objective was to ensure that the clinician who is facing a patient with a possible or already established arrhythmia has gained, after reading the book, all the information necessary to diagnose arrhythmias, understand ECG tracings, and obtain a good clinical history. I also aimed to teach about the prognosis of certain conditions, including the risk of possible complications such as stroke, cognitive impairment, and sudden death, so that the clinician could decide what the most appropriate treatment is.

In order to reach this goal, the book is divided into three sections.

In the first section, the concept, classification, and clinical aspects of arrhythmias are 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 physical examination. The characteristics of each type of cardiac cell are described and, finally, the most important electrophysiological mechanisms associated with cardiac arrhythmias are also discussed.

The second section describes the key elements used to carry out an electrocardiographic diagnosis of the various active and passive arrhythmias, their clinical and prognostic implications, and the best available treatments, using a practical approach. The current use of antiarrhythmic agents and the various techniques (cardioversion and ablation) and implantable devices (pacemakers, defibrillators, etc.) available are also briefly discussed (these topics are discussed more extensively in the Appendix).

In Chapter 7, the reader will find out how to perform an analytical study and differential diagnosis of different arrhythmias.

The third section deals with the most frequent arrhythmological syndromes, including pre-excitation and channelopathies, as well as other electrocardiographic patterns suggestive of increased risk of sudden death.

Finally, in the Appendix, a few concepts that are necessary to understand the literature are expanded on: sensitivity, specificity, and predictive values. In this section, new antiarrhythmic agents and novel techniques for diagnosis and treatment are covered. Guidelines issued by the most important scientific societies are also mentioned.

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.

All the information is presented in a cohesive way, although at times it may result in repetition of some aspects and concepts. I am aware of this, but believe it to be useful, particularly to the nonexpert, in order to reinforce basic knowledge and ideas. At the same time, the reader is very often referred to further information, either by cross-references related to other sections of the book or by reference to sections just before ("see before") or after ("see after") in the same chapter. I believe that this makes the book more harmonious and allows to the reader to interact better with other parts of the book. Additionally, at the end of each chapter, there are self-evaluation questions, the answers to which may be found on the pages of the book where the corresponding "letter tag" appears in the margin.

In terms of bibliography, a list of updated recommended texts for general reference is provided after this preface. In addition, at the end of each chapter, there is a list of specific references pertaining to each particular subject. The name of the first author of each of these articles has been cited in the text in an appropriate position.

I am sure, therefore, that after reading this book the reader will have learned all the basic concepts needed to face the often difficult problems of immediate diagnosis based on electrocardiographic tracings. I hope the reader will not only understand the most important clinical, prognostic, and therapeutic implications of the diagnosis in every case but also will acquire more confidence in this task.

This book is the result of many years of teaching cardiology, especially electrocardiography and arrhythmias. It is a source of pride for me to have Valentin Fuster and Pedro Brugada, two of the greatest representatives of cardiology in the world on both sides of the Atlantic, Catalans like me and good friends of mine since the beginning of time, honor me by writing glowing forewords for the book. I feel that their words not only complement the work but also express its meaning for the general cardiologists, cardiology residents, and internists.

I am very pleased that the book was very well received by general practitioners and clinical cardiologists, and when the Publisher decided to produce a second edition I suggested that an update of all the information given in the text, especially in relation to diagnostic criteria, new types of drugs and devices, and new prognostic implications, was needed. It was also very important to provide an update on new electrophysiological techniques, such as all types of pacemaker, new Holter devices, ICDs, CRT, and, especially, ablation techniques, including the new devices for LAA closure, and so on. This update had to be not only related to the technical aspects of the procedures but especially devoted to a discussion of when each technique should be indicated and the most characteristic aspects of each one of them.

In order to help this book evolve into a classic "Textbook of Clinical Arrhythmology", we decided that it was necessary for the new edition, and especially for future editions, to incorporate a co-author who would bring a new flavor but maintain the philosophy of a book of one author (not a book written by many authors each with different points of view and one editor-in-chief). This was for me a crucial point.

In order to do this, we decided to invite Professor Adrian Baranchuk, Head of the Heart Rhythm Service from Queen's University, Kingston, Ontario, Canada, to become a co-editor of the book. Adrian has demonstrated to me all the requirements that I have explained before: he is a very good clinician and an excellent and up-to-date invasive electrophysiologist, with a great teaching vocation and an extraordinary capacity to transmit knowledge. Therefore, he was for me the best person to transform a second edition of the book into an updated one that includes all the new aspects of our profession developed during the last five years whilst simultaneously maintaining all the characteristics of an authoritative author book. I have worked with him in different projects for the last few years and I was very confident that he has, without any doubt, the adequate scientific profile to perform this task.

I hope that the scientific community will receive the book enthusiastically as a "textbook" for cardiology fellows, internal medicine and emergency residents, medical students, general practitioners and allied professionals.

Lastly, I thank very much all the collaborators that have contributed to the first edition and that continue to contribute in this second edition. I also welcome the new contributors to this second edition. Additionally, thanks very much to our mentors and many other collaborators that have supported us in many aspects. Great appreciation must be shown to the amazing secretarial support from our beloved Montse Saurí and Esther Gregoris, and especially to my family, my wife María Clara for her constant support and all my five children and their families.

Preface to the Second Edition by Dr Adrian Branchuk

Now, I will introduce Adrian Baranchuk to write the second part of this foreword.

It is certainly not "common place" when an opportunity arises like the one Professor Bayés de Luna has given me to join him as co-author of the second edition of Clinical Arrhythmology. I am thrilled, honored, and challenged by this offer. I have carried out all my medical education in Argentina, reading from Professor Bayés de Luna's books and listening to him delivering talks and teaching large audiences all around the world. To me, he represents all that I wanted to achieve in my academic career. I still cannot believe that I have the opportunity to discuss electrocardiography, arrhythmias, and cardiovascular diseases with him. Dr Bayés de Luna is a super active physician, an avid researcher, and a spectacular mentor.

When he invited me to co-author this amazing book (the first edition of which I had on my shelf), I accepted immediately without knowing what I was getting into.

I have read and revised each line of this incredible treasure. There is so much to learn from this book!

He asked me to look at it with my "young eyes" (he called it "young blood") to be sure that we were not missing any new relevant information. I did my best to accommodate summaries of all new techniques, both for diagnosis and treatment. I am sure that I have missed a few important issues, and I hope we will correct these omissions in the next edition.

The last five years of my career have been enlightened by the constant presence of Professor Bayés de Luna. His advice both in the areas of academic medicine and also in more personal aspects of my life, have produced a change in how I face medicine, and how I balance my...