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A 29-year-old female with Uhl's anomaly developed complete atrioventricular (A-V) block. His bundle studies revealed block distal to the His bundle recording site with narrow QRS complexes. Right ventricular capture could not be obtained and despite successful left ventricular epicardial pacing, the patient died. Autopsy revealed absence of myocardium in most areas of the right ventricle and the right side of the ventricular septum with a normal tricuspid valve. Conduction system examination revelaed total destruction of both bundle branches. This is the first case where bilateral bundle branch block is shown to be present in Uhl's anomaly. Narrow QRS complexes probably reflected the absence of right ventricular forces.

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Serologic findings in cardiac patients who had no manifestations of drug-induced lupus and who had been taking procainamide for 6 weeks or more were compared to a similar group receiving quinidine, and a series of age-and sexmatched controls. Significant changes occurred only in the group of 22 patients ADD IN 1962 first described a case of L procainamide-induced systemic lupus erythematosus (SLE).l During the past 5 years an additional 49 cases have been reported.2-1S The entity has now become a well-recognized form of chemically induced SLE. Our experience with 6 additional cases suggested that the syndrome may be far more common than realized and that serologic abnormalities might occur in asymptomatic patients. The first patient tested by one of us (E. L. D.) had a strongly positive LE cell test without symptoms (Table 1). The aim of this study was to review a group of asymptomatic patients receiving procainamide to determine the incidence of antinuclear antibodies (ANA).l6 Two control groups of patients were evaluated: one a quinidine-treated series of comparable sex and age who were taking medication for essentially the same disorder as the procainamide group, and a second group of similar age and sex with miscellaneous disorders who were receiving neither drug. MATEFUALS AND METHODSAll available asymptomatic patients (those who had no manifestations suggestive of drug-induced lupus ) receiving procainamide or quinidine were included in the study. A series of 90 controls taking neither drug was also studied. Those with inflammatory and connective tissue diseases were excluded. The patients were otherwise selected as randomly as possible from among hospitalized medical patients until an appropriate number were obtained in each sex and decade. The majority suffered from degenerative cardiovascular disease. The following tests were done: rotary and rotarywashed clot LE cell preparations in the drugtreated groups,l7 immunofluorescent tests for ANA using as substrates calf thymus nucleoprotein and calf thymus DNA spots,ls total complement,lU and rheumatoid factor.20 Tests for ANA reacting with nuclei in rat liver sections18 were done on all