Decrease in mortality by propranolol in patients with heart disease and complex ventricular arrhythmias is more an anti-ischemic than an antiarrhythmic effect

We reported in a prospective, randomized study of 245 patients (mean age 81 years) with heart disease, complex ventricular arrhythmias, and a left ventricular ejection fraction of ≥40% that, compared with no antiarrhythmic drug, propranolol caused a 47% significant decrease in sudden cardiac death, a 37% significant decrease in total cardiac death, and a 20% insignificant decrease in total death.¹ Follow-up 24-hour ambulatory electrocardiograms were obtained in 112 of 123 patients (91%) treated with propranolol and in 109 of 122 patients (89%) treated with no antiarrhythmic drug. This article presents data correlating the reduction in mortality by propranolol with reduction in complex ventricular arrhythmias and in abolition of myocardial ischemia.