Atriogenic diastolic reflux: 46 years later.

A 59-year-old man was admitted for shortness of breath due to complete atrioventricular block. A transthoracic echocardiogram was performed to assess left ventricular ejection fraction before pacemaker implantation. Color Doppler recordings in the apical views revealed 2 small and central diastolic transmitral and transtricuspid reverse flows (Figure, A and online-only Data Supplement Movie I), concurrent with a mild aortic regurgitation (Figure, B and online-only Data Supplement Movie II). These reverse diastolic flows started after a nonconducted P wave and ended after the next P wave as demonstrated by color M-mode and pulsed-wave–Doppler recordings of both transmitral (Figure, D and F) and transtricuspid flows (Figure, C and E). Atrioventricular (AV) diastolic regurgitation was first described as atriogenic diastolic reflux in patients with AV block by Rutishauser et al in 1966 with the use of