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August 4, 1951, Vol 146, No. 14 >
Other Articles | August 4, 1951

AURICULAR FIBRILLATION

Myron, M.D.; Robert Oblath, M.D.; Eliot Corday, M.D.; I. C. Brill, M.D.; H. E. Kruger; L. Allen Smith, M.D.; Joshua Fields, M.D.; Rexford Kennamer, M.D.; John A. Osborne, M.D.
[+] Author Affiliations

Work by Dr. Oblath was performed during his tenure as research fellow of the American Heart Association.

This work was made possible by the financial support of the Beaumont Trust Fund (founded by Louis D. Beaumont).

Read before the Section on Internal Medicine at the Ninety-Ninth Annual Session of the American Medical Association, San Francisco, June 29 1950


Los Angeles

From the Institute for Medical Research, Cedars of Lebanon Hospital, and the Department of Medicine, University of California School of Medicine.


JAMA. 1951;146(14):1275-1281. doi:10.1001/jama.1951.03670140001001
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References

In past decades, many of the ablest medical investigators have attempted to resolve the mechanism of auricular fibrillation, the most important disturbance of the human heartbeat. The inconclusive nature of the results obtained by these workers undoubtedly is attributable to the fact that they did not utilize direct methods and their tools were not sufficiently sensitive to analyze the complex activity in the fibrillating auricles. For example, it it understandable that Sir James MacKenzie could not resolve the complex mechanism of auricular fibrillation from observations based solely on crude pulse tracings. The various earlier hypotheses were largely abandoned in 1920 when Sir Thomas Lewis, after extensive experimentation, advanced the circus movement theory. In the present investigation, the fibrillating auricle in man and animals has been reexamined with techniques not previously employed and apparatus not hitherto available. By these new methods the circus movement theory of auricular fibrillation has been found

REFERENCES

1 +
Aubert, E., and Dehn: Arch. ges. Physiol. 9: 115, 1874;
2 +
Garrey, W. E.:  Auricular Fibrillation , Physiol. Rev. 4:215, 1924;.
3 +
Kronecker, H., and Schmey, F.:  Das Coordinationscentrum der Herzkammerbewegung , Sitzungsber. k. Akad. Wissens 1:87, 1884;.
4 +
McWilliam, J. A.:  Fibrillar Contraction of the Heart , J. Physiol. 8:296, 1887;.
5 +
Engelmann, T. W.:  Über den Einfluss der Systole auf die motorische Leitung in der Herzkammer, mit Bemerkungen zur Theorie allorhythmischer Herzstörungen , Onderzoek. ged. h. physiol. Lab. d. Utrecht 74, 1896.
6 +
Lewis, T.:  Auricular Fibrillation and Its Relationship to Clinical Irregularity of the Heart , Heart 1:306, 1910;.
7 +
Winterberg, H.:  Studien über Herzflimmern: Mitteilung über die Wirkung des Nervus vagus und accelerans auf das Flimmern des Herzens , Arch. ges. Physiol. 117:223, 1907;.
8 +
Mackenzie, J.: Diseases of the Heart , ed. 3, London, Oxford University Press, 1913;.
9 +
Rothberger, C. J., and Winterberg, H.:  Ueber Vorhofflimmern und Vorhofflattern , Arch. ges. Physiol. 160:42, 1914;.
10 +
Porter, W. T.:  On the Results of Ligation of the Coronary Arteries , J. Physiol. 15: 121, 1893;.
11 +
Garrey, W. E.:  Auricular Fibrillation , Physiol. Rev. 4:215, 1924;.
12 +
Lewis, T.: The Mechanism and Graphic Registration of the Heart Beat , ed. 3, London, Shaw & Sons, Ltd., 1925;.
13 +
Goodman, L., and Gilman, A.: The Pharmacological Basis of Therapeutics: A Textbook of Pharmacology, Toxicology, and Therapeutics for Physicians and Medical Students , New York, The Macmillan Company, 1941;.
14 +
Andrus, E. C.; Carter, E. P., and Wheeler, H. A.:  Refractory Period of the Normally-Beating Dog's Auricle with a Note on the Occurrence of Auricular Fibrillation Following a Single Stimulus , J. Exper. Med. 51:357, 1930;.
15 +
Brams, W. A., and Katz, L. N.:  The Nature of Experimental Flutter and Fibrillation of the Heart , Am. Heart J , 7:249, 1931;.
16 +
Scherf, D.; Romano, F. J., and Terranova, R.:  Experimental Studies on Auricular Flutter and Auricular Fibrillation , Am. Heart J. 36:241, 1948;.
17 +
Oppenheimer, B. S., and Friedman, A. O.:  Early Observations on the Mechanism of Auricular Fibrillation , Cardiologia 16:308, 1950;.
18 +
Prinzmetal, M.; Corday, E.; Brill, I. C.; Oblath, R. W.; Kruger, H. E.; Fields, J.; Flieg, W.; Goldman, A.; Karpman, H.; Kennamer, S. R.; Osborne, J. A.; Sellers, A. L., and Smith, L. A.: The Auricular Arrhythmias , Charles C Thomas, Publisher, Springfield, Ill., to be published.
19 +
The presence of a P' wave in auricular flutter has been demonstrated.
20 +
Since the etopic focus of auricular fibrillation lies in cardiac muscle, the possibility exists that any agent that drastically depresses auricular conductivity would tend to prevent the conduction of impulses out of the ectopic focus and consequently would slow the rate of discharge from the focus.
21 +
Sokolow, M.:  Quinidine in the Treatment of Benign Auricular Fibrillation with Repeated Emboli , Am. Heart J. 18:497, 1939;.
22 +
Hart, T. S.:  Quinidin in Auricular Fibrillation , Arch. Int. Med. 30:593 ( (Nov.) ) 1922;.

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1 +
Aubert, E., and Dehn: Arch. ges. Physiol. 9: 115, 1874;
2 +
Garrey, W. E.:  Auricular Fibrillation , Physiol. Rev. 4:215, 1924;.
3 +
Kronecker, H., and Schmey, F.:  Das Coordinationscentrum der Herzkammerbewegung , Sitzungsber. k. Akad. Wissens 1:87, 1884;.
4 +
McWilliam, J. A.:  Fibrillar Contraction of the Heart , J. Physiol. 8:296, 1887;.
5 +
Engelmann, T. W.:  Über den Einfluss der Systole auf die motorische Leitung in der Herzkammer, mit Bemerkungen zur Theorie allorhythmischer Herzstörungen , Onderzoek. ged. h. physiol. Lab. d. Utrecht 74, 1896.
6 +
Lewis, T.:  Auricular Fibrillation and Its Relationship to Clinical Irregularity of the Heart , Heart 1:306, 1910;.
7 +
Winterberg, H.:  Studien über Herzflimmern: Mitteilung über die Wirkung des Nervus vagus und accelerans auf das Flimmern des Herzens , Arch. ges. Physiol. 117:223, 1907;.
8 +
Mackenzie, J.: Diseases of the Heart , ed. 3, London, Oxford University Press, 1913;.
9 +
Rothberger, C. J., and Winterberg, H.:  Ueber Vorhofflimmern und Vorhofflattern , Arch. ges. Physiol. 160:42, 1914;.
10 +
Porter, W. T.:  On the Results of Ligation of the Coronary Arteries , J. Physiol. 15: 121, 1893;.
11 +
Garrey, W. E.:  Auricular Fibrillation , Physiol. Rev. 4:215, 1924;.
12 +
Lewis, T.: The Mechanism and Graphic Registration of the Heart Beat , ed. 3, London, Shaw & Sons, Ltd., 1925;.
13 +
Goodman, L., and Gilman, A.: The Pharmacological Basis of Therapeutics: A Textbook of Pharmacology, Toxicology, and Therapeutics for Physicians and Medical Students , New York, The Macmillan Company, 1941;.
14 +
Andrus, E. C.; Carter, E. P., and Wheeler, H. A.:  Refractory Period of the Normally-Beating Dog's Auricle with a Note on the Occurrence of Auricular Fibrillation Following a Single Stimulus , J. Exper. Med. 51:357, 1930;.
15 +
Brams, W. A., and Katz, L. N.:  The Nature of Experimental Flutter and Fibrillation of the Heart , Am. Heart J , 7:249, 1931;.
16 +
Scherf, D.; Romano, F. J., and Terranova, R.:  Experimental Studies on Auricular Flutter and Auricular Fibrillation , Am. Heart J. 36:241, 1948;.
17 +
Oppenheimer, B. S., and Friedman, A. O.:  Early Observations on the Mechanism of Auricular Fibrillation , Cardiologia 16:308, 1950;.
18 +
Prinzmetal, M.; Corday, E.; Brill, I. C.; Oblath, R. W.; Kruger, H. E.; Fields, J.; Flieg, W.; Goldman, A.; Karpman, H.; Kennamer, S. R.; Osborne, J. A.; Sellers, A. L., and Smith, L. A.: The Auricular Arrhythmias , Charles C Thomas, Publisher, Springfield, Ill., to be published.
19 +
The presence of a P' wave in auricular flutter has been demonstrated.
20 +
Since the etopic focus of auricular fibrillation lies in cardiac muscle, the possibility exists that any agent that drastically depresses auricular conductivity would tend to prevent the conduction of impulses out of the ectopic focus and consequently would slow the rate of discharge from the focus.
21 +
Sokolow, M.:  Quinidine in the Treatment of Benign Auricular Fibrillation with Repeated Emboli , Am. Heart J. 18:497, 1939;.
22 +
Hart, T. S.:  Quinidin in Auricular Fibrillation , Arch. Int. Med. 30:593 ( (Nov.) ) 1922;.

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