To the Editor. —
Alpert and Flaker1 have contributed an excellent review of arrhythmias associated with sinus node dysfunction. I wish to take exception to only one item, which, unfortunately, is a recurring source of confusion in many publications. In the author's Table 1, they list acute pericarditis as a cause of sinus node dysfunction. Is there a reference that actually demonstrates even their definite association (if not cause)? While it is not inconceivable that a sick or lazy sinus may be found in a patient who happens to have pericarditis, it has been shown in elegant anatomic studies that acute pericarditis does not invade the sinus node proper, although it can infiltrate the zone around it.2 Moreover, LeKieffre and colleagues2 assert that at postmortem examination they have "never seen a patient with pericarditis and arrhythmia who did not also have disease of the myocardium or valves."