Dissimilar Atrial Rhythms Seen by Transesophageal Echocardiography During an Electrophysiology Study

Dissimilar atrial rhythms describe the coexistence of atrial fibrillation in one atrium and a more regular rhythm in the other. Electrograms are typically used to diagnose this rare entity. The use of transesophageal echocardiography in this context has not been described previously. We present a case of an 88-year-old woman with paroxysmal atrial fibrillation and new-onset, symptomatic atrial flutter who underwent electrophysiology study that confirmed dissimilar atrial rhythms. Transesophageal echocardiography images reveal differential function of the left and right atrial appendages, a novel finding that may be useful in diagnosing this rhythm disorder.