Why do we need another book about atrial fibrillation? Despite the numerous good books available on the topic, there are several reasons I think it is worthwhile writing yet another book about atrial fibrillation (AF). Fibrillation involves elegant physiology that is not widely taught or understood, and as a result there are widespread misconceptions or illconceived beliefs about AF. Electrophysiology (EP) in general is an aesthetically attractive intellectual endeavor: it makes sense and lends itself well to deductive reasoning. If you think about the fundamental principles of EP, you can figure out most things, with no need for rote memorization. AF takes this deductive process to extremes: “if this is true, then that must be true,” ad nauseam. We start by thinking about propagation in waves that traverse the tissue. Next, we think about more than one wave propagating at the same time, and consider how they interact. The outcome of such interactions is widely varied and depends in large part upon the timing and location of wave collisions. In AF there are numerous waves, traveling in random directions at random intervals, and hence the “space of possible interactions” is perpetually scanned; everything that can happen does happen.
This roiling, random, and chaotic activation seems inscrutable and unpredictable. However, as we will see in this book, the immense complexity of activation during AF becomes tractable via consideration of the principles of waves and their interactions. There is a second important reason to delve deeply into AF: we don’t currently have adequate treatments. The inadequacy is in part due to our inability to identify what drives AF in individual patients. There is still wide disagreement among the “experts” as to what the mechanism of AF in humans is. What type of problem is fibrillation? For a long time now, academic institutions have been organized around specific disciplines: biology departments, mathematics departments, etc. This binning has been quite useful, helping to focus intellectual pursuits into discrete groups. There are many types of problems. Some – like “At what angle should I tilt my canon to maximize the distance that my cannonballs fly?” – are mono‐disciplinic. Answering this question really only requires Newtonian mechanics. It can be solved entirely within the physics department, without need for outside consultation. There are, however, other types of problems that are more complex and do not lend themselves to analytic solutions (i.e. a formula which takes inputs and produces inevitable outputs).