[Lown-Ganong-Levine syndrome].

statement for it is not unlike the statement that we made in the conclusions of our review on page 426. We stated: "There are at present no conclusive data in the medical literature to support the concept that ACBG is superior to adequate medical management to prevent or even ameliorate other signs and symptoms of ischemic heart disease , such as myocardial infarction, arrhythmia and congestive heart failure. The procedure therefore is not recommended for these purposes. The main message that we hoped to emphasize in the review' was that it is indeed surprising after 10 years of experience with between 300,000 and 400,000 patients that we do not know the answer to such important questions. In my judgment, many surgeons and car-diologists believe that surgery does prevent myocardial infarction. If the procedure did in a significant manner prevent myocardial infarc-tion would one not expect it to be apparent after such an extensive and prolonged experience? As has often been said, "it did not take a randomized study to demonstrate the efficacy of penicillin in the treatment of pneumococcal pneumonia" or "to be different there must be a difference." Our conclusion that ACBG should not be recommended for the purpose of prevention of a myocardial infarction still appears to be justified. Dr. Hammermeister indicated that our discussion of his paper on the "Effect of Aortocoronary Saphenous Vein Bypass Grafting on Death and Sudden Death"6 may have been misleading. This was not our intent. Figure 1 in his paper showed the Seattle Heart Watch angiographic registery. Three and 56 deaths are identified as "procedural" among the patients reported as being dead in the medically and surgically treated groups, respectively. It is not clear, even now after rereading the manuscript several times, how one is to ascertain that the procedural deaths were excluded from the results of those patients not dying suddenly. Furthermore, the meaning of the classification is not clear even now; nor is it clear why there was such a striking difference, even considering the differences in the size of the two study populations, in the number of procedural deaths among surgical5 6 and medical3 patients. If we erred in the interpretation of this study we apologize. It is difficult to comment on Dr. Hammermeister's disagreement about our concluding statement in the summary: "Available data in the literature do not necessarily indicate that the initial symptomatic improvement necessarily persists." The …