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Sinus rhythm with absent P waves in advanced rheumatic heart disease

  • Author Footnotes
    * Wellcome Trust Research Fellow.
    A. Hafiz Khan
    Footnotes
    * Wellcome Trust Research Fellow.
    Affiliations
    From the Department of Medicine, Division of Cardiovascular Disease (Clinical Cardiology), Royal Postgraduate Medical School, Hammersmith Hospital, London, England
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  • Riaz Haider
    Affiliations
    From the Department of Medicine, Division of Cardiovascular Disease (Clinical Cardiology), Royal Postgraduate Medical School, Hammersmith Hospital, London, England
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  • Author Footnotes
    † R. S. McLaughlin Foundation Fellow.
    Derek R. Boughner
    Footnotes
    † R. S. McLaughlin Foundation Fellow.
    Affiliations
    From the Department of Medicine, Division of Cardiovascular Disease (Clinical Cardiology), Royal Postgraduate Medical School, Hammersmith Hospital, London, England
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  • Celia M. Oakley
    Affiliations
    From the Department of Medicine, Division of Cardiovascular Disease (Clinical Cardiology), Royal Postgraduate Medical School, Hammersmith Hospital, London, England
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  • John F. Goodwin
    Correspondence
    Address for reprints: John F. Goodwin, MD, Department of Medicine (Clinical Cardiology), Royal Postgraduate Medical School, Hammersmith Hospital, London W 12, England.
    Affiliations
    From the Department of Medicine, Division of Cardiovascular Disease (Clinical Cardiology), Royal Postgraduate Medical School, Hammersmith Hospital, London, England
    Search for articles by this author
  • Author Footnotes
    * Wellcome Trust Research Fellow.
    † R. S. McLaughlin Foundation Fellow.
      This paper is only available as a PDF. To read, Please Download here.
      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.
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