Archana Patel, MD; Daniel Goldman, MD
To 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
Patel A, Goldman D. Syncope and Functional Infranodal Block. Ann Intern Med. ;113:994–995. doi: 10.7326/0003-4819-113-12-994
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Published: Ann Intern Med. 1990;113(12):994-995.
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