No recounting better illustrates the combination of fortuity, plodding hard work, inspiration, and creativity necessary to the progress of a medical discipline than does this text about the evolution of our understanding of cardiac rhythm disorders.

Although our current understanding of arrhythmias depends on precise measurements and certain diagnoses supported by sophisticated technology, more ethereal concerns drew the ancients to study the heart and its rhythms. Aristotle (a relative latecomer; the relation between the heartbeat and the peripheral pulse had been theorized more than a millennium earlier) saw the heart as the bridge between the soul and the other bodily organs. Nearly a century before Wenckebach made his ground-breaking observations, which created the foundation of modern arrhythmia diagnosis, Beethoven set his own rhythm disturbance to music. Thus, the history of our understanding of rhythm disorders is unique and is especially interesting to students of cardiology, who can appreciate its richness and variety. This text relates this history and is a readable, well referenced, and richly illustrated little gem that should do its author proud.

The book is logically organized into five sections. The first details historical developments. Before electrocardiography, diagnoses were made by analyzing the peripheral pulse. The electrical origin of this mechanical event was not appreciated until the development of the electrocardiograph (beginning with the string galvanometer of Einthoven) in the late 19th and early 20th centuries. The second section recounts the pathogenesis and symptoms of cardiac disease. The seminal descriptions of Stokes, Adams, and Gallavardin are well detailed, as are the later contributions of Wolff, Parkinson, White, and Lown and those who described the structure and function of the conduction system. The third section describes the invasive and noninvasive techniques used to diagnose cardiac arrhythmias, but it is cursory and fails to recognize the contribution of many important pioneers in the field of electrophysiology (Josephson and Cox, for example).

The fourth section is a fascinating account of the historical development of antiarrhythmic drugs. The book closes with a section on the history of defibrillation, pacing, and surgical and catheter-based ablation techniques. This section is likely to become quickly dated, given the rapid growth of knowledge in this area.

The book clearly fills a niche, but its readability, good presentation, and excellent illustrations should make it appealing to others besides the electrophysiologist and general cardiologist. For those of us interested in rich anecdotes to spice up rounds or a lecture, this is an excellent source.

John U. Doherty, MD

Pennsylvania Hospital

Philadelphia, PA 19107