Josephson Clinical Cardiac Electrophysiology


This book is and will always be Mark’s book. My role is to lovingly curate and update Mark’s phenomenal experi ence and wisdom to the best of my ability. Taking on this task underscored just how much I have left to learn and, even more, how many ques tions I wish that I could dis cuss with him. All references to clini cal experience and all strong opinions are Mark’s. For

clinical practice. Unfortunately, these new therapeutic tools have captured the imagination of young electrophysiologists to such an extent that terms such as ablationist , defibrillation ist , or implanter are used to describe their practice. Their zest for the application of such therapeutic modalities has been associated with a decrease in the emphasis of understand ing the mechanisms, clinical implications, and limitations of the therapeutic interventions used to treat arrhythmias. Such behavior is often associated with a lack of, or limited, critical thought that is essential to the development of a new therapeutic concept. There should be the development of a hypothesis, questioning the rationale of the hypothesis, and testing the hypothesis prior to widespread application of the therapeutic strategy.” “The purpose of this book is to provide the budding elec trophysiologist with an electrophysiologic approach to arrhyth mias, which is predicated on the hypothesis that a better understanding of the mechanisms of arrhythmias will lead to more successful and rationally chosen therapy. As such, this book will stress the methodology required to define the mechanism and site of origin of arrhythmias so that safe and effective therapy can be chosen. The techniques suggested to address these issues and specific therapeutic interventions employed represent a personal view, one that is based on experience and, not infrequently, on intuition.”

greater emphasis, his words are marked with italic text in the present edition. I have left as many of these from the prior editions as possible. We have argued over some of these opin ions in the past; almost invariably I have been wrong. Points of view that have become less tenable in the face of advancing knowledge have been edited, but these were few. In this spirit, the unedited words from the preface of the fifth edition follow. “The past 50 years have witnessed the birth, growth, and evolution of clinical electrophysiology, from a field whose initial goals were the understanding of arrhythmia mecha nisms to one of significant therapeutic impact. The develop ment and refinement of implantable devices and, in particu lar, catheter ablation have made nonpharmacologic therapy a treatment of choice for most arrhythmias encountered in

David J. Callans, MD Philadelphia, Pennsylvania

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