In this issue (see p 1423), Whiting suggests that treatment of premature ventricular contractions is indicated in selected groups of patients (some asymptomatic) with chronic ischemic heart disease and ventricular dysrhythmia. The appeal of this approach is at least partially based on the premise that it is possible to identify patients with ischemic heart disease and a high risk of sudden death. Given the detection of high-risk groups, it does seem reasonable to assume that suppression of arrhythmia using antiarrhythmic drugs (with careful quantification of ventricular dysrhythmia) is appropriate.
However, we think that this suggested approach to the management of arrhythmia in ischemic heart disease patients should be subjected to further scrutiny. Our approach will be based on a statement of three premises that we believe are supportable based on our current state of knowledge.
—Antiarrhythmic drugs are antiarrhythmic drugs, and not placebos. Quinidine sulfate, procainamide hydrochloride, disopyramide