Paroxysmal Heart Block in Bundle Branch Block.

When a patient is suspected of having Stokes-Adams disease the electrocardiogram is of critical importance, particularly in respect of the auriculo-ventricular (A-V) conduction time. Should this not be prolonged, the possibility of paroxysmal heart block remains, although the diagnosis of Stokes-Adams disease is uncertain without some degree of heart block recorded graphically. It is not known how far major impairment of intraventricular conduction (bundle branch block) with a normal P-R interval predisposes to A-V dissociation, and, therefore, to Stokes-Adams attacks. This matter is here considered.