Since the development by Zoll1of an external cardiac pacemaker capable of producing effective ventricular contractions by transthoracic electric stimulation many cases of asystole have been successfully treated with the aid of this device alone or in combination with intravenous administration of isoproterenol (Isuprel) hydrochloride.2The majority of the reported cases have been those of chronic atrioventricular block with Stokes-Adams disease. Recently we had opportunity to apply this regimen to a patient in whom an advanced second degree atrioventricular block with Stokes-Adams attacks developed acutely in the course of a myocardial infarct. (The term "advanced second degree atrioventricular block" is applied to cases in which several successively dropped beats initiate atrioventricular nodal escape and dissociation with or without ventricular captures.3) To our knowledge this is the first such case with survival treated in this manner. Continuous monitoring of the rapidly changing cardiac mechanism in conjunction with automatic