Recent years have witnessed a change in the assessment of ventricular ectopic beats. Prognostic gears are shifting from complacent optimism to uneasy apprehension. Even though the epidemiologic studies at Framingham1 reassure us that in the absence of evident coronary heart disease or left ventricular hypertrophy these beats seldom herald sudden death, we lack confidence in this reassurance. Only in the young with no organic heart disease are ventricular extrasystoles completely innocuous.
Analyzing the data of the Tecumseh epidemiologic study over a six-year period, Chiang et al2 noted that of 165 persons over the age of 30 years who had premature beats, ten died suddenly (61 per 1,000) as compared with 35 of 3,459 (10 per 1,000) who manifested no ventricular ectopic activity.
Even more pronounced is the association of ventricular premature contractions with sudden death in older people. Among 301 active men of median age 55 years, reported