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December 4, 1967

Ventricular Fusion Beats

JAMA. 1967;202(10):991. doi:10.1001/jama.1967.03130230117034

To the Editor:—  The patient reported by me (201:566, 1967) had persistent complete AV block, with idioventricular rhythm for more than six months before he entered the hospital. At no time did the electrocardiograms show conducted beats. The pacemaker of the idioventricular rhythm apparently shifted from time to time. The accompanying tracings recorded on Nov 3, 1966 (Figure, top) and Nov 8 (Fig, bottom) illustrate this point. The ventricular rate in both instances was about 30 per minute.Two idioventricular pacemakers, having similar rates and firing almost synchronously, have been reported.1 Mild irregularity of the QRS intervals is not uncommon in idioventricular rhythm. Slight delay of the pacemaker responsible for the right bundle-branch type QRS configuration after the eighth beat resulted in a shift of the pacemaker to that producing the other type of QRS configuration. All the evidence indicates that the rhythm illustrated in the report, "Ventricular