Dr. Sidney Jick, Associate Attending Physician, the Jewish Hospital of St. Louis, and Clinical Instructor in Medicine, Washington University School of Medicine: A 67-year-old business executive with a 20-year history of chronic atrial fibrillation was hospitalized in February 1967 because of recurrent palpitation during slight exertion. During the past 20 years, despite large doses of digitalis and other drugs including quinidine sulfate, the patient often experienced episodes of rapid heart action, particularly on very modest effort. In 1965, cardioversion was successfully performed with 400 watt-seconds, but normal sinus rhythm was maintained for only two days.
Physical examination revealed an elderly white man in no distress. Pulse rate was 78 beats per minute and irregular; blood pressure was 130/95 mm Hg and respiration rate was 16 per minute. Findings from examination of the head, ears, eyes, nose, throat, abdomen, and extremities were unremarkable. The chest was clear to percussion and auscultation.