Fred Kusumoto - ECG Interpretation: From Pathophysiology to Clinical Application

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It has been a decade since the first edition of this book was first released. During this time, there have been many important advances in our understanding of the electrophysiology of the heart that have been incorporated into this edition. For example, new pacing techniques are now widely used for the treatment of selected patients with heart failure and conduction abnormalities. One of the goals of the last book was to provide information beyond the basics of ECG interpretation without being unwieldy or encyclopedic. I have tried to keep this goal in mind and have supplemented the chapters while trying to keep the chapters short, clinically relevant, and easily readable in a single session. However, this edition goes beyond the first edition by presenting more advanced concepts in ECG interpretation with more examples and figures. Most of these new concepts are contained in a completely new chapter that discusses ECG interpretation using a patient-centric approach. I am hopeful that this will allow the reader to understand in what situations the ECG provides important clinically relevant information while maintaining the original vision of the book.

One of the greatest pleasures of this book has been meeting colleagues from around the world who have used this text to help them understand ECG interpretation from an anatomic and electrophysiologic perspective. In particular, I would like to thank Maxim Didenko from St. Petersburg, Russia, who is not only an outstanding clinician but also one of the foremost anatomists in the world. I have learned much from our discussions on anatomy and electrophysiology, and the reader will see many figures from his anatomic laboratory in this new edition that help illustrate the correlation between anatomy and then ECG. As my career in medicine has progressed, I have recognized the true importance of mentors, and as I did in the first edition, I would like to thank Tom Evans and Mel Scheinmann for their many teaching points and insights on ECG interpretation. Nora Goldschlager, who I thanked in the first edition as one of my teachers who instilled a love of ECG reading in me, has been a true mentor for all things during my professional career. I only hope that I can have a similar effect on my students.

I would like to thank Garth Haller for agreeing to pursue this new edition and his understanding for the usual delays that a large project like this encounter throughout its development. Finally, I would like to thank my family for their understanding for the time away that both this edition and the last edition have taken me away from them. It makes me chuckle to think of the hand pictures that are used to explain the conduction system of the heart, as I am reminded that my adult children were once children children and how proud I have been to watch them become adults. I am blessed.

Why write another book on ECG analysis and interpretation? Although there are a number of superb introductory and comprehensive books on ECG interpretation, there are very few books that provide the reader information beyond the basics, other than encyclopedic texts. In addition, ECG reading has been traditionally taught using pattern recognition. However, over the past two decades there has been a tremendous explosion of basic research that has transformed our understanding of the basis of the ECG. Finally, teaching ECGs has often been done by stand-alone lectures that have little clinical context; or worse, no organized teaching of ECGs is available because of the tremendous demands of the increasing depth and breadth of medical knowledge that must be mastered during medical school, training, and beyond to become a consumate clinician.

This book has been written to fill these gaps. Although this book provides basic information on ECG analysis it also attempts to explain the electrophysiologic underpinnings for the ECG. Traditional findings such as ST segment elevation are explained with a framing case for each chapter with a series of clinically based questions at the end designed to help the student understand the importance of the ECG in clinical medicine. Finally, the book ends with a discussion and series of clinical problems that will help the reader develop a personal style for ECG analysis. In the end I hope the reader finds this text useful for learning how to interpret ECGs in the context of patient care.

This book grew out of a series of lectures on ECG analysis I have given at the University of California, San Francisco; the University of New Mexico; and the Mayo Clinic, Jacksonville. I would like to thank the many students, residents, and colleagues that contributed to this project. I would also like to thank my three mentors that taught me ECG analysis over the years: Nora Goldschlager, Mel Scheinman, and Tom Evans. I appreciate the patience of Melissa Ramondetta for letting this project evolve over a very long time. Finally, I would like to thank my family for putting up with the constant typing and the missed soccer games and school plays that a task like this inevitably requires.