Nonpharmacological Management of Atrial Fibrillation Edited by Francis D. Murgatroyd and A. John Camm (review)

volume Stands as a series of studies of how scientist's bodies were imagined and how scientists imagined the bodies of Others. As such it is good casebook for the new history of science. Is this a good thing? My biases are clear. I believe that one can only understand the science if its frame is made visible. Repeating the claims of the scientists for their own inventions and discoveries provides a map of how the scientists saw the world; how they imagine themselves in it as human beings with bodies and minds, with social position and beliefs, is missing from such narratives. It is not that the science is purely the result of its contexts—one can argue that science could be understood as a transcendental force in modernity—but that the humanness and complexity of the scientist vanishes once his or her science is reduced to a simple link in a chain of progress. The complex tale of how science works is almost always made more comprehensible by seeing how the scientists imagined their own world of work. One can not explain Newton's physics by his dietary habits, but one can more easily imagine Newton as inhabiting a world as difficult and complex as one's own when we think about what he was supposed to eat (or better, what he was supposed not to eat.) Science, like all human endeavor, is a product ofpeople, and that is what makes the story interesting for most of us. Enjoy this volume. I can promise you will never eat a chicken again without thinking of Isaac Newton. Sander L. Gilman Henry Luce Professor of the Liberal Arts in Human Biology The University of Chicago Nonpharmacological Management of Atrial Fibrillation. Edited by Francis D. Murgatroyd and A. John Camm. Armonk, NY: Futura Publishing, 1997, Pp. 560. $120. The swift evolution and clinical application of advanced devices and diagnostic and ablation techniques has provided the interventional electrophysiologist with modalities to effectively manage nearly all clinically important arrhythmias. Treatment of atrial fibrillation remains problematic, however, with medical options limited by modest efficacy and problematic toxicity. Current nonpharmacologic management options are similarly limited, and maintenance of sinus rhythm is often abandoned in favor of less optimal clinical endpoints. Direct ablation of atrial fibrillation is in its infancy, with at least several years of research and testing required before it becomes a conventional technique. Nevertheless, with an increasing understanding of the basic mechanisms of atrial fibrillation and with the development of advanced mapping, ablation, and device-based techniques, successful interventional treatment of atrial fibrillation now seems to be nearly within reach. Nonpharmacological Management ofAtrial Fibrillation provides a timely compilation of state-of-the-art reviews relevant to both clinicians and scientists with an interest in progressive atrial fibrillation management. The text clearly reflects the current 150 Book Reviews emphasis in atrial fibrillation investigation on the practical aspects ofbasic research. Authors are all respected investigators, and many are genuine pioneers in the field of atrial fibrillation investigation. Collectively, they provide the current status of our understanding of the electrophysiological substrate and nonpharmacological treatment of atrial fibrillation. Preliminary results of radiofrequency catheter ablation , pacing-related interventions for atrial fibrillation, and the implantable atrial defibrillator are reviewed. The clinical problem of atrial fibrillation is exceptionally well summarized by Crijns, et al., in the opening chapter. Important practical aspects pertaining to AV nodal blockade are discussed in detail. The electrophysiological substrate of atrial fibrillation is reviewed in particular detail, including animal models, determinants of susceptibility, and mapping of atrial fibrillation. As might be expected, investigators eagerly await results of radio-frequency catheter-based approaches to the ablation of atrial fibrillation. Haissaguerre, et al., describe their initial experience with radio-frequency catheter ablation of paroxysmal atrial fibrillation. I expect that for those familiar with the electrocardiographic pattern of salvos of atrial tachycardia or fibrillation (typically in patients without structural heart disease), the characterization of lone "focal" atrial fibrillation and/or rapid atrial tachycardia arising from the pulmonary veins, crista terminalis, or eustachian ridge/ coronary sinus will be of particular interest. It would have been satisfying to see more detailed data on ablation of chronic atrial fibrillation. Nevertheless, the overview...