Excerpt from The American Journal of the Medical Sciences, 1919, Vol. 157
In the case of auricular fibrillation I have often wished that I might be able to pick out by graphic methods the more serious cases, as one can do in pulsus alternans, as I have shown above. By exam ining the Table one sees some clues which help one in this attempt. For this selection electrocardiograms are necessary. Patients who Show auricular fibrillation complicated by aberrant ventricular complexes or by ectopic ventricular contractions have a much graver prognosis than the uncomplicated auricular fibrillation, much more than twice as grave, especially in the case of the aberrant ventricular complexes, Where in my small group of cases the mor tality was 100 per cent. Within three years. Such a finding might be expected because the electrocardiograms indicate serious myo cardial damage or irritability in the ventricles. Such diseased or hyperirritable ventricular muscle does not stand up under the strain of auricular fibrillation the way relatively healthy ventricular muscle does. It is probable that one may regard these two conditions complicating auricular fibrillation as important as the presence of pulsus alternans in the case of a non-fibrillating heart. In fact, one of the patients tabulated above as having aberrant ventricular com plexes and auricular fibrillation combined had been seen by me before his heart became arrhythmic and a radial pulse tracing at that time showed pulsus alternans.
Further confirmation of these findings in larger groups of cases would be of interest. The prognostic value of electrocardiograms as well as of radial pulse tracings is brought out by this investiga tion, the former especially as regards auricular fibrillation and the latter as regards alternation of the pulse.
Summary. 1. Three groups of 100 patients each, showing (1) pulsus alternans, (2) auricular fibrillation and (3) normal rhythm, have been studied with relation particularly to prognosis. A large number of each group has been followed for two or three years and the condition determined at the end of that time.
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