Cardiac Pacing and Defibrillation in Pediatric and Congenital Heart Disease

Anesthesiologists taking care of children and young adult patients with congenital heart disease are frequently faced with patients with pacemakers and/or defibrillators. The majority of these devices need to be reprogrammed for a safe surgical procedure. In addition, due to the high need for diagnostic imaging in these patients, knowing magnetic resonance imaging device compatibility is essential for the anesthesiologist. The field of pediatric electrophysiology has evolved rapidly in the last few years, and a comprehensive but readable book was due on this subject. The book Cardiac Pacing and Defibrillation in Pediatric and Congenital Heart Disease edited by Drs Shah, Rhodes, and Kaltman is written to address the progress in the pacemaker, resynchronization, and defibrillation. The authors’ ultimate goal in publishing this book is to craft a comprehensive and informative resource for the trainee, clinical cardiologist, and electrophysiologist. Last, all the contributing authors are national and international leaders in electrophysiology, including industry researchers. The book is written in a didactic form with ample illustrations and summarizing tables. Furthermore, at the end of the book, for the neophyte in the subject, there is an extensive reference list for those interested in expanding their knowledge and terminology. The book is currently available in hardcover with additional website content or as an eBook. The website content is limited in that it includes only multiple-choice questions for most of the chapters and some educational videos. As a reviewer for an Anesthesiology Journal, I found parts 2 (clinical concepts) and 3 (implantation techniques) to be the most valuable for the pediatric anesthesiologist. The indications for permanent pacing and automatic implantable cardioverter-defibrillators are revised succinctly. Recommendations on device and lead selection, including manufacturers, dimensions, and capabilities, are clearly made. Advanced pacemaker and automatic implantable cardioverter-defibrillator features are analyzed, such as rate-adaptive atrioventricular delay adjustment, sleep mode, and antitachycardia pacing. The chapter on the hemodynamics of pacing and cardiac resynchronization therapy (CRT) for the failing left and right ventricle illustrates the relationship between electrical activation and function. CRT is capable of improving function by restoring synchrony especially in the high-risk congenital heart disease population (eg, failing single ventricles). CRT is not a widespread technique, and only those working in busy heart failure centers may find this section of importance. I found of practical value the considerations for device implantation, such as anatomy of the cardiovascular system, patient and vessels size, and implantation in unique scenarios (eg, left superior vena cava, d-transposition postatrial switch, or bioprosthetic tricuspid valve). The anesthetic management of these patients is beyond the scope of this book even though the need of a skilled anesthesiologist is mentioned. The permanent epicardial pacing chapter examines thoroughly the indications, types, implantation techniques, high-risk populations, and complications so the anesthesiologist could foresee them. The chapter on managing device-related complications and lead extraction is probably the 1 with utmost interest for the anesthesiologist because the majority of these life-threatening complications are managed under anesthesia and the anesthesiologist has a critical role in a patient’s ultimate outcome. Last, the device programming and follow-up section of the book is of little significance for the pediatric anesthesiologist. The book finishes presenting information on quality of life, sport participation, and the envisioned future for arrhythmia and heart failure therapy. My recommendation is that the book Cardiac Pacing and Defibrillation in Pediatric and Congenital Heart Disease is a comprehensive electrophysiology textbook ideal for the library of a pediatric anesthesia department, although I would not recommend the book as a must-buy for the pediatric anesthesiologist. As a pediatric cardiac anesthesiologist, I enjoyed reading several chapters, and I definitely see it as a formidable reference tool. Alternatively, the rest of the anesthesia community may find this book too in depth or not as relevant for their clinical practice. Pablo Motta, MD, FAAPPerioperative and Pain MedicineBaylor College of MedicineArthur S. Keats Division of Pediatric Cardiovascular AnesthesiologyTexas Children’s HospitalHouston, Texasemail protected