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(Circulation. 1968;37:1020.)
© 1968 American Heart Association, Inc.

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Temporal Alternation of Atrial Flutter Sounds

D. EMSLIE-SMITH M.D., F.R.C.P.E., M.R.C.P.¹ E. H. O. PARRY M.D., M.R.C.P.¹

¹ From the Department of Medicine, Royal Postgraduate Medical School, London, England.

A case of atrial flutter is reported in which the hearing of "systoles en écho" led to the recognition in the phonocardiogram of a regularly alternating time interval between successive atrial sounds during the ventricular standstill caused by stimulation of the carotid sinus. A possible explanation is proposed involving alternating pathways of atrial excitation.

Key Words: Atrial conduction pathways • Internodal tracts • Circus movement • Atrial excitation • Systoles en écho