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Auricular Fibrillation and Pulsus Alternans

Robert L. Pitfield, M.D.
JAMA. 1915;LXV(5):448. doi:10.1001/jama.1915.02580050076028.
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To the Editor:  —Dr. Harold E. B. Pardee (The Prognosis of Auricular Fibrillation, The Journal, June 19, 1915, p. 2057) uses the following phrase in his concluding sentence: "the irregularity, per se, adds little or nothing to the gravity of the prognosis." According to Lewis, the irregularity of the pulse of auricular fibrillation is the most common of the seven different varieties of arrhythmic pulse, and, of course, one of the gravest.That the irregularity, per se, has nothing to do with the prognosis is well exemplified in the following case: A man, aged 58, has had this type of irregular pulse since he was 33. He has no valve lesion, dilatation or other muscle disease or weakness; he has had no dyspnea or decompensation. There is no history of infectious disease, such as rheumatism, which might damage the conductivity and integrity of his heart muscle. Three times he was


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