Retrograde atrial conduction with complete heart block following implantation of an internal ventricular pacemaker.

54-YEAR-OLD WHITE MAN WAS ADA mitted to the hospital because of Morgagni-Adams-Stokes attacks of ten months duration. As a child, the patient had frequent episodes of epistaxis and pharyngitis. At age 34, he was rejected for military service because of a "heart murmur." The Morgagni-Adams-Stokes episodes increased in frequency and severity, and one week prior to admission, several episodes of syncope with convulsions occurred upon attempting to stand in the upright position. On examination, the patient was pale and apprehensive. His temperature was 9g°F., blood pressure was 160/70 mm. Hg, and the apical pulse, 31 beats per minute. There was moderate distention of cervical veins with large atrial waves occasionally noted. The left ventricular impulse was palpated at the anterior axillary line between the sixth and seventh ribs, and the first apical sound varied in intensity. A grade I1 holosystolic murmur and an intermittent third sound were heard at the apex and along the left *From the Department of Medicine, Vanderbilt Univenity School of Medicine. sternal border. The electrocardiogram COMPLETE HEART BWCK WITH RETROGRADE ATRIAL CONWCTlON