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Doody's Review ServiceReviewer: Ralph J. Damiano, MD (Washington University School of Medicine)
Description: This comprehensive overview of the state-of-the-art of surgical treatment of atrial fibrillation (AF) uses a multidisciplinary approach with contributions from anatomists, cardiologists, and surgeons. Divided into five sections, it begins with a review of the anatomy and physiology as well as the pharmacological treatment of AF. The authors then provide a look at both the historical and currently used surgical techniques for AF. Short sections cover catheter ablation and treatment of congenital cardiopathies.
Purpose: This is intended as a review of surgical treatment of AF, a worthy objective since this is a field that has undergone rapid evolution over the last 10 years, with the introduction of a number of new operations and ablation technologies. Unfortunately, the book does not completely meet its objectives and leaves readers without clear guidance on the appropriate approach to the patient.
Audience: Surgeons and cardiologists involved in the treatment of patients with AF are the intended audience. The editors have assembled a collection of experts from around the world who are all authorities in the field.
Features: The first section deals with the anatomy, pathophysiology, and electrophysiology of the atrium and atrial fibrillation. The second reviews the history of surgery for AF and the most successful procedure, the Cox-Maze operation. The third section covers recent modifications of the Cox-Maze procedure. The last two sections review catheter ablation and complications of surgery. The strongest part of the book is the excellent chapter on the anatomy of the atria by Dr. Anderson and colleagues. It is beautifully written with excellent illustrations. Unfortunately, the rest of the book does not match up to the quality of this chapter. The sections on the pathophysiology and pharmacology of AF are particularly weak, and the latter section never mentions the recently published guidelines by the ACC/AHA/ESC on the management of patients with AF. The third section is a good review of current surgical approaches, but suffers from poor illustrations of operative techniques and a lack of uniformity in presenting the surgical results. Moreover, the microwave section does not mention the poor experimental and clinical results in the U.S. which led to the removal of these devices from the market. The chapter on alternative energy sources is also weak, and ignores most of the published experimental literature on these devices. No attempt is made to highlight the advantages or disadvantages of each technology. The final section, "Perioperative Complications, Reporting Results and Statistical Analysis," is woefully inadequate and disappointing, including only a brief, far from comprehensive description of complications, with no mention of the importance of patient follow-up and reporting results.
Assessment: This is an interesting compilation of information on the surgical treatment of AF. Unfortunately, the quality of the chapters is variable and there is a lack of consistency in the illustrations and the reporting of results. Much of the information is already outdated, and the book does not even refer to the recent guidelines and consensus statements published regarding AF and ablation. While it is a reasonable review, the book provides physicians with little guidance regarding the plethora of new technologies and procedures available for the surgical treatment of AF.