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The authors highlight that block of early atrial premature beats below the His bundle can be physiologic rather than pathologic, questioning the necessity of a permanent pacemaker in this context.
Letters15 December 1990Syncope and Functional Infranodal BlockArchana Patel, MD, Daniel Goldman, MDArchana Patel, MDSearch for more papers by this author, Daniel Goldman, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-113-12-994 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the Editors:We read with interest the article by Manolis and colleagues (1) and offer the following comments. Their Figure 6 shows an early atrial premature beat that blocks below the bundle of His, and in the legend the authors state, "The probability of intermittent heart block causing syncope in this patient was sufficiently high to merit a permanent pacemaker" (1). We would like to point out that block of early atrial premature beats below the His bundle can be a physiologic type of block with no pathologic significance, because in some patients the effective refractory period of the...References1. ManolisLinzerSalemEstes AMDN. Syncope: current diagnostic evaluation and management. Ann Intern Med. 1990;112:850-63. LinkGoogle Scholar2. JosephsonSeides MS. Clinical Cardiac Electrophysiology: Techniques and Interpretations. Philadelphia: Lea & Febiger; 1979:45-8. Google Scholar3. WitWeissBerkowitzRosenSteinerDamato AWWKCA. Patterns of atrioventricular conduction in the human heart. Circ Res. 1970;27:345-59. CrossrefMedlineGoogle Scholar4. AkhtarDamatoCaractaBatsfordJosephsonLau MAAWMS. Electrophysiologic effects of atropine on atrioventricular conduction studied by His bundle electrogram. Am J Cardiol. 1974;33:333-43. CrossrefMedlineGoogle Scholar5. DamatoVargheseCaractaAkhtarLau APAMS. Functional 2:1 AV block within the His-Purkinje system: simulation of type II second degree A-V Block. Circulation. 1973;47:534-42. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Jersey City Medical Center Jersey City, NJ 07304 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 15 December 1990Volume 113, Issue 12Page: 994-995KeywordsAtrial premature beatHeartPacemakersSyncope Issue Published: 15 December 1990 PDF DownloadLoading ...
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