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November 1982

New Echocardiographic Observations in a Patient With Dissimilar Atrial Rhythms

Author Affiliations

From the Second Department of Internal Medicine, University of Occupational and Environmental Health School of Medicine, 807 Kitakyushu, Japan.

Arch Intern Med. 1982;142(12):2215-2217. doi:10.1001/archinte.1982.00340250181032

• A patient with an impure flutter was found to have dissimilar atrial rhythms that were confirmed by direct ECG recordings. Echocardiographic studies disclosed that the a waves on the mitral echocardiogram occurred synchronously with the a waves on the esophageal ECG that, in turn, showed atrial flutter at a rate of 300 beats per minute. However, the a waves on the tricuspid echocardiogram coincided closely with the P waves on a surface ECG (lead V) that disclosed a chaotic atrial tachyarrhythmia. These results suggest that echocardiographic study, in conjunction with an esophageal ECG, may be a useful, noninvasive technique for the diagnosis of dissimilar atrial rhythms.

(Arch Intern Med 1982;142:2215-2217)