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May 30, 1966

Simulation of Ectopic Ventricular Rhythms by Aberrant Conduction

JAMA. 1966;196(9):787. doi:10.1001/jama.1966.03100220079026

The electrocardiogram is indispensable for unravelling complex arrhythmias. Yet the tracing can lead the uninformed astray in the presence of the simplest disturbances of rhythm. Aberrant ventricular conduction is a common occurrence and it is the basis for much arrhythmic confusion. What looks ventricular in origin is not necessarily so; and although the philosophy "Why diagnose when you can convert?" is spreading in this age of electric miracles, more thoughtful therapists still know that there are practical as well as intellectual advantages in knowing what tachyrhythm confronts them.

When a descending impulse reaches the ventricular conducting system and finds part of it blocked or refractory, the impulse is forced to travel by a devious route and writes an anomalous QRS complex. If this state of affairs is more or less permanent and the QRS-T pattern is characteristic, we call the disturbance "bundle-branch block." If, however, the alteration in the QRS

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