Hemodynamics in atrial flutter with spontaneous reversion to normal sinus rhythm

During cardiac catheterization of a 31-year-old woman with mitral stenosis, the development of atrial flutter and subsequent spontaneous reversion to normal sinus rhythm provided an opportunity to study the hemodynamic effects of the arrhythmia under ideally controlled conditions. The ventricular rate remained constant; no cardiac drugs were administered, and the patient, who was neither aware of the arrhythmia nor had symptoms referable to it, remained in a fairly stable, steady state. Neither cardiac output nor pressure levels in the heart and the pulmonary vascular bed were altered significantly by the atrial flutter. Evidence of mitral and tricuspid insufficiency appeared during the arrhythmia but was not present during sinus rhythm. The valvular dysfunction was related to the current concept of the importance of normal atrial contraction to adequate closure of the atrioventricular valves.