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High-Grade Atrioventricular Blocks

Brendan Phipps, MD
JAMA. 1985;254(1):57. doi:10.1001/jama.1985.03360010063021.
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To the Editor.—  From the exchange of ideas between the report of our committee published in the Sept 14,1984, issue of JAMA1 and the editorial comments in the same issue,2 it has become clear that two questions require sharper definition.First, on behalf of our committee, I would like to state that the editorial comments were well taken and were, in fact, largely included in our original draft. (The need to shorten a manuscript from 103 to 35 pages necessitates certain deletions!) In our original article, we commented that clinical judgment must play a role given an adequate substrate of objective information—we specifically mentioned the case of the patient with bifascicular block, and syncope that could not be explained after careful diagnostic study, for whom a trial of pacing might be considered, particularly if the consequences of syncope might be catastrophic.In this context, however, the phrase "strongly


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