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Carotid sinus syndrome (SSC) is quite rarely associated with malignancy of the head and neck. We report a case of mixed type of SSC coupled to a left parapharyngeal centroblastic polymorphic non-Hodgkin lymphoma with high degree of histological malignancy. Syncope was the starting symptom and diagnosis, suspected on the ground of objective local signs, was settled by neck CT. Histological identification was performed after the tumor was surgically removed. Paralysis of left vocal cord and left cervical sympathetic nerve resulted associated with disappearance of spontaneous hypotensive events. The complex diagnostic program, often borne by such patients, stimulates to a critical review.

Out of 4000 vectorcardiograms, 23 of them showed the most tipical pattern of left posterior hemiblock (BFP). According to the vectorial characteristics, they were divided into 5 groups; only two groups (for a total of 8 cases) showed, according to the Authors' opinion, the characteristics of the isolated BFP. The diagnostic difficulties of such a conduction disturbance are discussed since, it simulates, the vectorial pattern of the vertical heart. Moroever there is an underlining possibility that conduction disturbances in the right heart coexist in many cases of supposed isolated BFP with marked axis rotation to the right. The Authors agree with the hypothesis already expressed by Polu on the vectorial progress of the isolated BFP which should have an AQRS of about 70 degrees; an exact electrocardiographic diagnosis might be therefore impossible.

The AA. have analysed 39 VCG which show terminal slowed down forces definitely directed towards the right and the back. It is presumed that such electrical patterns have to be classified amongst defects which deal with right intraventricular conduction. Both the ECG and UCG test have been classified in groups: some of them simulating BFA, others BFP. An analysis of the different developing ways of the vectorial loops has been made. The AA. think that in some cases the particular direction of the terminal forces could be compatible with an isolated and zonal right conduction defect in the posterior region of the right ventricle. In other cases the coexisting electrical pathology of the left ventricle is likely to be responsible for it. At the end the distinguishing diagnostic criteria of the ECG are discussed.

The diagnosis of Left Posterior Fascicular Block based on clinical ECG and VCG tracings alone is possible when ECG and VCG allow to recognize asynchronous left ventricular activation. The delayed inscription time of the intrinsecoid deflection in aVF (or V6) in absolute and relative to aVL permits the diagnosis if intrinsecond deflection in aVL exceeds 0,035". Il more premature, a further control is required to distinguish Left Ventricular Hypertrophy from Left Posterior Fascicular Block, both in anatomically vertical heart.

This report describes a case of Wolff-Parkinson-White syndrome with atrial fibrillation in which the ventricular complexes conducted over the accessory pathway have promptly disappeared with the use of intravenously administered lidocaine. Lidocaine is suggested as the most suitable drug in such situations. Finally possible connections are presented between high dosage administered lidocaine and conversion to normal sinus rhythm.