Arrhythmia prophylaxis: Long-term suppressive medication

The author describes the notions that led to initiation of controlled trials of long-term medication with antiarrhythmic drugs following myocardial infarction, and reviews reports of controlled trials with diphenylhydantoin, alprenolol, and procaine amide. It is concluded that, so far as possible widespread prophylactic use of these drugs to prevent sudden death is concerned, diphenylhydantoin has no place, while procaine amide cannot be evaluated on a large scale because of the frequency with which it causes serious adverse reactions. There is no bar to an extended trial with alprenolol or comparable beta-blocking drugs. The author believes that nonspecific prophylactic long-term use of antiarrhythmic drugs to prevent sudden coronary death outside the hospital is unlikely to prove rewarding.