Persistent atrial quiescence in adult rheumatic heart disease

The first adult patient with catheterization-proven isolated rheumatic heart disease who demonstrated the electrophysiologic findings of "persistent atrial quiescence" is described. Metabolic causes of transient atrial sequence were effectively excluded by clinical history and appropriate laboratory studies. Atrial quiescence may be the electrophysiologic expression of end-stage rheumatic atrial pathology seen only in cases of advanced, surgically uncorrected rheumatic mitral valve disease.