Journal of electrocardiology
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A 60 year old man suffering from syncope believed to be due to the sick sinus syndrome was treated with a permanent demand ventricular pacemaker. This led to almost continous bouts of paroxysmal supraventricular tachycardia (SVT) over the ensuing two years, mistakenly believed to be part of the sick sinus syndrome. Careful study showed that this man had a type A Wolff-Parkinson-White accessory atrioventricular connection which consistently conducted retrogradely, but only rarely antegradely, during applications of carotid sinus massage. ⋯ All episodes of SVT stopped when the ventricular pacemaker was removed. Following insertion of an atrial pacemaker, the patient had no episodes of SVT or syncope over a nineteen month follow-up period. This case illustrates the care required in selecting a proper site for protective pacing in patients who suffer from paroxysmal SVT.
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Methodological differences in the placement of precordial ECG electrodes are a major problem in multicenter clinical trials and epidemiological studies. Trend analysis and realization of the full potential of computer programs for serial comparison demands reduction of technical sources of variation in the electrocardiogram (ECG) and vectorcardiogram (VCG) and particularly errors in locating ECG electrodes. The ECG electrodes locator described here reduces a major precordial uncertainty in the identification of the midclavicular and the anterior axillary lines. It simplifies positioning and provides a numeric record of the key precordial electrode positions, facilitating control of electrode placement errors in serial recordings.