Patient-related factors are as important as procedure-related factors in determining risk for post-ERCP pancreatitis. These data emphasize the importance of careful patient selection as well as choice of technique in the avoidance of post-ERCP pancreatitis.

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Studies of ventricular depolarization with multichannel recording technics permit detailed three dimensional analysis of the process. Activity commences on the mid left septal surface, followed by activity on the right septum. Rapid endocardial excitation follows and leads to endoepicardial activation of the walls. The latest areas activated are in the basal septum. These findings are related to the genesis of the normal QRS. Theories of simultaneous activation and eleetrocardiographic silent areas are discussed.

Multipolar recording techniques have been used to study excitation of the canine interventricular septum. Activity commences in the mid left septal endocardium and slightly later near the right anterior papillary muscle. From these sites depolarization spreads over the endocardial surfaces, probably via the Purkinje tissue, at 1 m./sec. and through the septal thickness at one-third this speed. Near the upper septum, bilaterally and on the posterior right there is a lack of the rapid endocardial conduction. Septal contribution to the QRS is considered.

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