Electrocardiography: Principles and practice

Electrocardiography: Principles and practice

Book Reviews of distinguishing Principles and PracElectrocardiography: tice, by Ernest Bloomfield Zeisler. Login Brothers, Chicago, 1960, pp. 374. ...

111KB Sizes 2 Downloads 340 Views

Book Reviews

of distinguishing

Principles and PracElectrocardiography: tice, by Ernest Bloomfield Zeisler. Login Brothers, Chicago, 1960, pp. 374.


in the statistical

from normal in the sense of healthy, in electrocardiography, The

Some textbooks on electrocardiography sacrifice validity for oversimplification and promulgate dogmas, errors and misconceptions. Dr. Zeisler attempts instead a more critical consideration of some important problems in electrocardiography. Some of his analyses involve careful study of the original work and full discussion down to minute details. This is a welcome departure even if one is compelled to point out a few serious defects in some of the excellent chapters. There are a number of diagrams but no In order illustrations of electrocardiograms. to follow many of the author’s discussions the reader will have to obtain the original papers. The author defends the empirical approach. He argues against a resultant vector in the body, the unipolarity of the V leads and the possibility of determining cardiac position from the electrocardiogram. He discusses the limitations in the diagnosis of ventricular hypertrophy and infarction, and he reviews theories of mechanism of the Wolff-Parkinson-White syndrome. He concludes that reciprocal rhythm and retrograde conduction to the atria from ventricular premature systoles occur not at all or only rarely. He presents a classification of heart block with five degrees. He reviews the theories of mechanism of atria1 fibrillation and Spatial vectorcardiography is disposed flutter. of in less than a page as a fad with the prediction that it will not prove clinically useful. The chapters on hypertrophy, infarct and WolffParkinson-White syndrome are the best. The chapter on the physical basis of electrocardiography says nothing about the fascinating and basic new studies with microelectrodes in individual myocardial fibers. The chapter on the normal electrocardiogram is inadequate; ranges of normal are given without data on distribution or frequency of deviations from these values in healthy people. There are limited data for children. The whole question



so important

is barely touched.


of what

he believes

to be serious errors in other texts is valuable. If his book accomplishes no more than to call attention to prevalent misconceptions about the relation of the electrocardiogram to cardiac position, it will serve a useful purpose. Sometimes one wishes though that he would drop the polemics with other texts to take on more formidable adversaries. The attack on Wilson’s concepts is more an attack on what some texts say than a detailed critique of Wilson’s and other relevant studies. There is more reference to other texts on the subject of the resultant dipole than to some important recent basic studies. A principle of least difficulty in the interpretation of the arrhythmias is, according to the author, presented here for the first time. It is the reviewer’s impression that something similar to such a principle must have been applied to the analysis of the first clinical Some readers and all subsequent arrhythmias. may question whether the principle has been applied in the author’s discussion of reciprocal retrograde conduction to the atria rhythm, from ventricular premature systoles and retrograde conduction in A-V block. Perhaps the author attempted too much. It may be impossible in 342 pages “to simplify the subject and to make it accessible and useful to the the medical student, the general internist, the cardiologist and the electrocardiographer” and, at the same time, undertake full discussion “with analysis of all the arguments on both Medical students and others with a sides.” general interest will probably avoid the book as an introduction to electrocardiography or as a main reference, largely because of the absence of illustrations. More serious students of electrocardiography should find the book provocative and interesting; careful study of the author’s arguments alongside the original papers ALBERT D. KISTIN, M.D. is worth while. 620