The results of this study indicate that patients with VT after radical correction of the TF have abnormal histopathological findings at the site of the prior right ventriculotomy scar. These lesions were noted within the region of delayed activation found during epicardial mapping and were found to be a part of the reentrant circuit.

Four orthogonal systems of vectorcardiography that are considered to be more accurate than th(-tetrahedron and cube systems were compared. In a large majority of subjects the records made with each of the 4 systems were similar. However, in 5 of 60 subjects in whom the Z lead was studied, dissimilarities were found that were considered to be significant. The possible reasons for these dissimilarities are discussed. Comparative normalization data for the systems were obtained in the living human subject, based upon comparison of wave forms.RECENTLY 4 systems of vectorcardiography based on well-established principles of potential theory have been devised by Schmitt and Simonson,1 Frank,2 McFee and Johnston,3 and Helm.4 They each attempt to provide a more orthogonal reference frame than the cube and the tetrahedron systems. It is the purpose of this paper to report the results of a comparative study in the living human subject of these 4 systems. The study was undertaken for 2 reasons, to determine how interchangeable the results of the different systems were and to provide comparative normalization data for each system in the living subject. If the systems yielded similar results, the study would serve as a consistency cheek on the validity of the separate methods of analysis and synthesis. METHODThe 3 leads of each orthogonal reference frame were compared individually. They were paired with a common lead to produce a loop rather than being recorded as scalar leads. The latter method requires high-speed, dual-channel recording with a common lead for phase relations, and analysis of such records was found to be less obvious and informative.All studies were performed with the subject recumbent. Loops were observed directly on an oscilloscope and photographed with a Polaroid Land Z Lead. Since the anteroposterior or Z lead has been the most variable component in existing systems of vectorcardiography, the major portion of this study was devoted to it. The Z lead of each system was paired consecutively with a common X lead (Schmitt system), and the gain of the Z channel controlled so that the peak-to-peak excursion was the same for all loops. The gain was then recorded for normalization information. The Z leads of the Frank and the Schmitt SVEC III systems were employed as described by these authors in their original communications.1' 2 The sponge electrode of Helm4 and the multiple bank of electrodes of McFee and Johnston3 are described as follows.The sponge electrode consisted of a thin plastic sponge moistened with a saturated solution of sodium chloride. Two sizes of sponge were used on the anterior chest wall to record the Z lead. A large sponge 10 inches square was positioned to cover the area from the first to the seventh interspace and from approximately the right midelavicular line to a line between the V4 and V5 positions. A smaller sponge with dimensions of 8Y2 inches from right to left and 612 inches from top to bottom was placed on the precordium, extending from the level of the second to the sixth rib a...

Two patients had bilateral cervico-thoracic sympatho-ganglionectomy for treatment of disabling symptoms due to refractory ventricular tachycardia. In both patients treatment with antiarrhythmic drugs singly, in combination, or together with pacemaker overdrive had been ineffective in controlling this arrhythmia.Both patients had normal coronary arteriograms.Bilateral thoracic svmpathectomv appears to facilitate medical management of ventricular tachycardia in selectecl patients wx ho are refractorv to the usual medical treatment. Additional Indexing Words:Refractorv ventricular tachvcardia Thoracic svmpathectomv RECURRENT VENTRICULAR TACHYCARDIA not associated with coronary disease is uncommon. There have been sporadic reports of ventricular tachycardia without other evidence of heart disease, and Lesch et al. collected 34 reports of such patients between ages 2 and 40.1 This report relates our recent experience with two patients who had normal coronary arteriograms and who had recurrent incapacitating ventricular tachycardia, which proved refractory to conventional measures. NMedical management of their arrhythmias was facilitated by bilateral cervico-thoracic sympathetic ganglionectomy. Prior experience with sympathectomy in this situation is reviewed. Case ReportsCase 1 Patient M.E., a 48-year-old Caucasian housewife, was first admitted to the Arizona Medical Center on July 24, 1973.The patient was in good health until one week prior to ad-Fromn the Sections of Cardiology and Cardiovascular Surgery,

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