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Editor's Correspondence
December 9/23, 2002

Intraventricular Block and Atrioventricular Conduction

Arch Intern Med. 2002;162(22):2635. doi:

Schwab and colleagues1 convey a valuable message about the risks of using trade names of prescribed drugs. The article, however, is marred by a conspicuous failure of the peer-review process (equally so for the ARCHIVES Web site). Figure A, presented as left bundle branch block during third-degree atrioventricular block cannot possibly be so interpreted. Bundle branch blocks and other intraventricular blocks require atrioventricular conduction to be recognized (unless the intraventricular block were reliably identified previously and had not changed). That is elementary electrocardiography. In this case, the odds are heavily on a slow idioventricular pacemaker. Moreover, the P-wave mean axis is probably over −30° with a positive P in lead aVR—an abnormal atrial pacemaker (P is slightly negative in lead II). It is particularly important in nonsubspecialty journals that the readers have reliable subspecialty information, although most internists should be aware of the ground rules of electrocardiography.

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