the bookshelf Those readers of CHEST interested in serving as reviewers for “The Bookshelf” are asked to notify the department editor, Lee K. Brown, MD, FCCP, at the following address: New Mexico Center for Sleep Medicine, Lovelace Health Systems, 4700 Jefferson Blvd. NE, Suite 800, Albuquerque, NM 87109. Please indicate your field(s) of expertise (pulmonary, cardiology, cardiothoracic surgery, critical care, or sleep), and include your curriculum vitae if available. In appreciation for completed reviews, authors may retain the book or software for their own use.
Atrial Flutter: From Mechanism to Treatment Albert L. Waldo, MD. Armonk, New York: Futura Publishing Company Inc, 2001; 64 pp; $16.00 The publication of Atrial Flutter: From Mechanism to Treatment is proof that good things can come in small packages. This 64-page monograph covers the topic of atrial flutter starting with a classification of atrial flutter types, proceeding to experimental models and human validation, and concluding with management of the patient with atrial flutter. The text is concise and well written, the illustrations are on-point, and an extensive bibliography will guide the interested reader to articles of further interest, both historical and clinical. The different classifications of atrial flutter have led to confusion for both clinicians and students of this dysrhythmia. Is this type I or type II flutter? Typical or atypical flutter? Clockwise or counterclockwise? Dr. Waldo takes the reader fluidly through this inconsistent area using representative electrocardiograms and illustrations, concluding with a review of the soon-to-be-published classification of atrial flutter, by the European Society of Cardiology/North America Society of Pacing and Electrophysiology Working Group. The discussion on mechanisms is divided between animal models and studies in human patients, with the section on animal models being particularly strong. Taking a historical approach, the contributions of Lewis et al, Frame et al, Allessie et al, and Dr. Waldo himself are described clearly, bringing the reader logically to our current level of understanding of the pathophysiology of atrial flutter. I particularly enjoyed Figure 6, a reproduction of the illustration and text from Dr. Lewis’ 1920 article published in Heart, which outlines a very accurate model of atrial flutter despite the limited technology available at that time. The companion section, concerning studies in humans, bridges the gap between basic science and clinical medicine. The entrainment techniques that confirmed a reentrant mechanism with an excitable gap are described, as are the right atrial mapping studies that delineated the anatomy of the atrial flutter circuit. These studies laid the foundation for the definitive cures now possible with radiofrequency ablation. Missing are intracardiac electrograms from clinical electrophysiology studies that would have further made the point that atrial flutter is due to macroreentry within the right atrium. Furthermore, examples of concealed entrainment from the atrial flutter isthmus would have more clearly proven the rationale for targeting this area during ablative therapy. The section on medical management of atrial flutter is concise, including a discussion of pharmacologic treatment of both acute and chronic flutter that is clinically relevant and quite up-to-date. The description of flutter occurring after the suppression of atrial fibrillation treated with intracardiac antiarrhythmic agents is one such example. This section is a distillation of current information combined with clinical judgment, adding to the wealth of clinical “pearls” sprinkled throughout Dr. Waldo’s monograph. Catheter ablative therapy for atrial flutter is the one notable weakness in this book. The review and a single illustration cover this area in adequate detail for the generalist. However, with ⬎ 90% of all atrial flutter being curable by radiofrequency ablation, I would have 692
expected intracardiac electrograms of clockwise flutter, counterclockwise flutter, and complete isthmus block, plus examples demonstrating the use of the newer, computer-assisted mapping systems. A discussion of strategies to evaluate incomplete isthmus block during ablative therapy also would have been appropriate, and together, these additions would have made the section on catheter ablative therapy more complete. This volume will be a welcome addition to the library of anyone interested in arrhythmias. For a student, generalist, or cardiologist this monograph provides useful information written by an eminent and experienced investigator in the field. For the electrophysiologist, Atrial Flutter: From Mechanism to Treatment will be one of several useful works on the bookshelf.
John H. Jentzer, MD Northeast Cardiology Associates Bangor, ME
Manual of Clinical Problems in Pulmonary Medicine, 5th Edition Richard A. Bordow, Andrew L. Ries, and Timothy A. Morris. Philadelphia, Pennsylvania: Lippincott Williams & Wilkins, 2000; 624 pp; $37.95 Manual of Clinical Problems in Pulmonary Medicine, 5th Edition is a useful addition to the growing collection of practical “how-to” books in the field of pulmonary medicine. Compiled in large part from contributions by the various members of the Department of Pulmonary and Critical Care Medicine at the University of California at San Diego (UCSD), with additional input from renowned authors in the field across the country, this volume presents a broad overview of the various day-to-day problems in clinical pulmonary medicine. Addressing the enormous issues in this field in a compact, precise manner is a Herculean task, and great effort has been made to provide important details without overshadowing the essential facts. The broad topics covered include the approach to commonly encountered symptoms, diagnostic procedures in pulmonary medicine, and a whole gamut of problems that every physician dealing with patients in this field will inevitably encounter, including infections, airway diseases, vascular disorders, and neuromuscular disease affecting the lung. In addition, special issues such as the effects of drug abuse, pregnancy, and influence of air travel and diving on the lung are succinctly addressed. The rapidly growing field of sleep medicine is recognized by way of updated chapters that provide important insight into the effects of sleep on respiratory function. Pulmonary hypertension and the various approaches to management of this heterogeneous disorder are particularly well addressed—not surprising, given the wealth of expertise on this topic available at UCSD. Last, but not least, the editors include useful information on the management of chronic obstructive lung disease (the major patient population of any pulmonary clinic), encompassing not only routine care issues, but also pulmonary rehabilitation and smoking cessation. Overall, given the constraints imposed by its size and by its expressed aim to serve as an immediate reference tool for clinicians in training, the Manual of Clinical Problems in Pulmonary Medicine, 5th Edition impresses as a compact, user-friendly, first-stop information source that is a portable, reliable, and useful addition to the library of anyone interested in the active practice of pulmonary medicine.
Srinivasan Devanathan, MBBS University of New Mexico Health Sciences Center Albuquerque, New Mexico