Appearance of atrial rhythm with absent P wave in longstanding atrial fibrillation.

A man with rheumatic heart disease and longstanding atrial fibrillation had an electrocardiogram that showed a regular rhythm without atrial activity. Through use of various techniques atrial depolarization was identified Other features of this rhythm disturbance included digitalis-induced Mobitz type 2 AV block, concomitant Mobitz type 1 and type 2 AY block and possible “lone left atrial rhythm” with electromechanical dissociation.

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