Atrial Fibrillation in Apparently Idiopathic Cardiomyopathy: The Chicken or the Egg?

In 1913, Gossage and Hicks reported the case of a previously healthy 23-year-old man who presented with dyspnea and chest pain and was found, on the basis of radial and jugular pulse tracings, to have atrial fibrillation and a rapid ventricular response [1]. On physical examination, there was no evidence of cardiomegaly. He was treated with tincture of digitalis and continued to have atrial fibrillation, and serial physical examinations demonstrated progressive cardiac enlargement. The patient died suddenly approximately 18 months after first presenting with atrial fibrillation. A postmortem examination demonstrated a dilated and hypertrophied left ventricle, with no valvular lesions and normal coronary arteries. Earlier contemporary studies had suggested that dilatation of the heart may be a common cause of atrial fibrillation, but, based on the findings in their patient, Gossage and Hicks concluded that dilatation of the heart may be caused by, rather than being the cause of, atrial fibrillation [1].