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Sinus rhythm with absent P waves in advanced rheumatic heart disease

1973; Elsevier BV; Volume: 32; Issue: 1 Linguagem: Inglês

10.1016/s0002-9149(73)80091-8

1879-1913

Ashfaque Khan, Riaz Haider, Derek R. Boughner, Celia M. Oakley, J. F. Goodwin,

ECG Monitoring and Analysis

Two patients with advanced rheumatic heart disease, whose surface electrocardiogram showed irregular rhythm and absent P waves, were studied with an intracardiac electrogram. Both were shown to have sinus rhythm. Mechanical failure of the atria was shown in 1 patient by pressure recordings and cineangiograms and suggested in the other by fluoroscopic study. The possibility that extensive myocardial fibrosis can cause the sinus impulse to travel through the internodal tracts to the atrioventricular node and then to the ventricles without depolarizing the atrium is discussed. In such patients, an absent P wave does not indicate atrial fibrillation or junctional rhythm. Two patients with advanced rheumatic heart disease, whose surface electrocardiogram showed irregular rhythm and absent P waves, were studied with an intracardiac electrogram. Both were shown to have sinus rhythm. Mechanical failure of the atria was shown in 1 patient by pressure recordings and cineangiograms and suggested in the other by fluoroscopic study. The possibility that extensive myocardial fibrosis can cause the sinus impulse to travel through the internodal tracts to the atrioventricular node and then to the ventricles without depolarizing the atrium is discussed. In such patients, an absent P wave does not indicate atrial fibrillation or junctional rhythm.