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I appreciate Dr Reiffel's letter regarding my article.
I respect Dr Reiffel's alternate hypothesis of an A-V nodal reentry rhythm. However, it is of interest that the QRS deflections of the slower terminating ventricular rhythm is so similar to the QRS deflection of the tachycardia rhythm, thus suggesting an identical origin of the depolarization impulse.
I agree completely with the desirability of intracardiac electrophysiologic study during the episode of rhythm disturbance for more definite detail. Unfortunately, the setting in which the situation occurred was one of a therapeutical nature and resources and facilities were not available for full research study, involving intracardiac electrophysiologic study. This, of course, would have been desirable.
Dr Reiffel's final comment is well stated concerning caution in using carotid sinus massage in attempts to terminate ventricular tachycardia in elderly patients due to the potential hazard of ventricular standstill. It would seem logical, however, that
Lorentzen D. Ventricular Tachycardia-Reply. JAMA. 1976;236(12):1354. doi:10.1001/jama.1976.03270130018014
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