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December 26, 1936


Author Affiliations


From the Department of Medicine, Washington University School of Medicine, and the Barnes Hospital, St. Louis.

JAMA. 1936;107(26):2099-2102. doi:10.1001/jama.1936.02770520001001

Some thirty years ago Mackenzie observed that in certain cases of auricular fibrillation a conspicuous reduction of ventricular rate follows the administration of digitalis. Mackenzie believed that the accompanying relief of symptoms probably was to be attributed to the slowing, a conception elaborated and strengthened by Sir Thomas Lewis. Knowing of no beneficial effect of digitalis on the musculature of the failing ventricle, Lewis referred clinical improvement entirely to reduction in rate. The slowing was explained as due to a measure of auriculoventricular block induced by a special action of the drug on the connecting tissues. Since block of moderate extent will slow the ventricle only in cases of auricular fibrillation, this explanation logically limited the use of digitalis to cases of that arrhythmia. Lewis has held, furthermore, that the existence of established fibrillation implies disease of ventricular muscle and that the congestive heart failure which is present in most

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