Sir, I read with interest the article about atrial fibrillation (BDJ 2008; 205: 539). For many years including when I was secretary of SAAD, I said that the ECG was an under used piece of monitoring in the dental surgery and that it would be only a matter of time before somebody found out why. My own anecdotal evidence is that a variety of undesirable rhythms can readily be seen before anybody even touches the patient.

Then I read a letter by some of the same authors where they criticise G. Manley et al. Later in the same letter, they say that it 'seems odd to be concerned about preoperative fasting where the loss of consciousness must be avoided'.

I sat back ... I thought I had read that the unexpected cardiac rhythm could occur in a nervous patient. I felt there could be an allusion to a more serious rhythm occurring unexpectedly. I thought it might not be that unusual for that type of patient to lose consciousness? Maybe? We sedate nervous patients. Nervous patients can vomit unexpectedly and I think you can assume that an empty stomach would be a help. I personally found that very very nervous patients are best advised to present with empty stomachs, bladders and bowels!

I think sometimes you can only walk away shaking your head realising that some people just don't get it!