We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |


Arch Intern Med (Chic). 1922;29(6):828-835. doi:10.1001/archinte.1922.00110060122007.
Text Size: A A A
Published online


I purpose, in this communication, to emphasize the distinction that should be made between the terms "reversed mechanism" and "reversed rhythm" of the heart.

The term "reversed mechanism" should be confined to express a reversal of the mechanism of impulse formation and conduction. Normally, the impulse originates in the sinus and traverses the auricles to be conducted through the auriculoventricular junctional tissues into both ventricles. In reversal of the mechanism, the impulse first originates in the auriculoventricular node, or the junctional tissues, or at a lower level in the heart and travels backward into the auricular musculature. Thus the term "reversed mechanism" implies a direction of stimulus conduction opposite to the normal.

Illustrative of such cases may be mentioned instances of auriculoventricular rhythm. In these cases, a ventriculo-auricular (R-P) interval may be exhibited with inversion or distortion of the auricular (P) wave. Williams and James,1 Heard and Strauss,2 White,3 and


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.