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Simulation of Ectopic Ventricular Rhythms By Aberrant Conduction

Albert H. Douglas, MD
JAMA. 1966;197(8):664. doi:10.1001/jama.1966.03110080104038.
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To the Editor:—  In a recent issue of The Journal, Marriott1 has properly redirected attention to the similarities and differences between the electrocardiographic patterns of supraventricular and ventricular arrhythmias. We are in full agreement with the author's contention that accurate diagnosis of these arrhythmias has become increasingly important with recent advances in therapy.Unfortunately, neither Marriott1 nor Sandler and Marriott,2 have listed the diagnoses in the cases they studied. In our experience, diagnostic problems of the type discussed have involved primarily patients with ischemic heart disease and it is this same group which most frequently confronts the physician with arrhythmias of ventricular origin which have serious prognostic implications.Furthermore, Marriott has assumed that impairment of conduction is the mechanism involved. The possibility of accelerated conduction as an explanation is an alternate hypothesis and this seems to account better for some cases of paroxysmal supraventricular tachycardia observed in ischemic


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