“…Therefore, it is not surprising that, in our experience, only a few of the epicardially paced patients, who constitute about 15 per cent of the entire series, had developed the complete syndrome. Certainly the observation does not imply that the epicardial mode of pacing is relatively inferior, for it has been repeatedly shown that the left ventricular myocardium is physiologically a better location for pacer lead implantation (Koltz et al, 1963;Vagnini et al, 1966;Furman and Norman, 1972;Brenner et al, 1974;Guharay et al, 1974). Nevertheless, the observation does point to risk entirely, nor does it produce collapse of the pocket on to the generator to give an optimally tight-fitting size and shape.…”