To the Editor.
—The article by Bharati and Lev1 in the September 1984 Archives was obviously intended to emphasize "the relationship of the conduction system and sudden death." As a consequence, the thrust of the article detailing various types of cardiovascular disease leaves the reader with the impression that gross or microscopic anatomic alterations can almost always be demonstrated in cases of cardiac sudden death. Some discussion, however, should be devoted to the important role of stress and coronaryprone behavior in this phenomenon. Sudden death may also result from increased secretion of stress-related catecholamines. While preexisting cardiovascular disease may facilitate this, it is equally apparent, in many cases, that there is no such evidence from autopsy findings.Mechanisms whereby stress can cause sudden death in the absence of overt cardiac disease are most likely related to the induction of lethal arrhythmias. In addition, direct cardiac damage can also result