The absence of ventricular premature beats on a Holter is like a normal sedimentation rate.

standard' for the assessment of the early results of percutaneous mitral commissurotomy, especially when a transseptal approach is used with its inherent risk of inter-atrial shunt [6]. Finally, the problem of cost is addressed in this study. Overall, we should remember that the duration of hospitalization was short (24 h) and that re-use of balloons is commonplace in developing countries. In fact, the comparison of costs in the present study is a comparison of the balloons used rather than the technique itself, with an advantage in favour of polyurethane balloons over the Inoue balloon. This study therefore demonstrates excellent results obtained using percutaneous mitral commis-surotomy in a country where rheumatic heart disease is endemic, where the patients are numerous, with favourable clinical and anatomical characteristics, and where the operators are able to perform a large number of procedures and thereby acquire a high level of expertise. This situation is, of course, the ideal field of application and can be achieved provided the means exist. Finally, the series of Dr Bahl is an important contribution to the literature concerning the retrograde technique. The study does not demonstrate the superiority of the retrograde technique over the antegrade approach, but suggests that the two approaches can be complementary, particularly in technically difficult cases. References [1] Inoue K, Owaki T, Nakamura T et al. Clinical application of transvenous mitral commissurotomy by a new balloon catheter. [3] lung B, Cormier B, Ducimetiere P et al. Functional results 5 years after successful percutaneous mitral commissurotomy in a series of 528 patients and analysis of predictive factors. [4] Stefanidis C, Stratos C, Pitsavos C et al. Retrograde nontrans-septal balloon mitral valvuloplasty. Immediate results and long-term follow-up. Circulation 1992; 85: 1760-7. [5] Bahl VK, Chandra S, Jhamb DK et al. Balloon mitral val-votomy: comparison between antegrade Inoue and retrograde non-transseptal techniques. The absence of ventricular premature beats on a Holter is like a normal sedimentation rate See page 1787 for the article to which this Editorial refers Hedblad et a/.' 1 ' report in this issue on the increased mortality from ischaemic heart disease (hazard ratio 30, 95% CI 1-7-5-2) during a 10-year follow-up of a cohort of 456 men aged 68 years (men born in 1914 in Malmo, Sweden) who had frequent or complex ventricular arrhythmias detected on a 24-h ambulatory (Holter) ECG recording. The increased mortality risk persisted after adjustment for history of coronary heart disease, …