Alternation of atrial cycle length in supraventricular tachycardia.

Nine cases of alternation of the atrial cycles during supraventricular tachycardia are presented, three of which were manifestly due to digitalis toxicity. They presented the following features: absence of 1/1 conduction, upright P waves in Lead II, atrial rates of 156-218. When alternation disappeared, the atrium adopted the longest of the previously inscribed cycles. A ventriculophasic cause was excluded. The possible mechanisms are discussed in terms of the known functional anatomy of the various forms of SVT.