Atrial Reciprocal Rhythm

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Abstract
The analysis of simultaneously recorded esophageal and other electrocardiographic leads of 5 patients is consistent with the interpretation of atrial reciprocal rhythm; an impulse from the Sino-auricular (S-A) node or an atrium somewhere in its course to or towards the ventricles turns back to activate the atria again. In support of the interpretation are: the evidence for 2 pathways of conduction in 2 of the cases, the 2 pathways providing a possible mechanism for reciprocal rhythm; the presence of partial atrio-ventricular (A-V) block in 2 of the cases, partial A-V block providing a possible mechanism for reciprocal rhythm; the configuration of the reciprocal P wave which is what would be expected from a retrograde activation of the atria and its resemblance to other P waves in the same tracing which seem to be the result of retrograde conduction after ectopic systoles, the occurrence of the reciprocal atrial activation after delayed A-V conduction which fits with conditions favoring the occurrence of reciprocal rhythm. Atrial reciprocal rhythm may occur even when there is A-V block somewhere below the juncture of the forward and retrograde components of the reciprocal pathway. Repeated reciprocal cycles and tachycardia may occur. The forward and retrograde pathways seem to meet somewhere above the bifurcation of the bundle of His.