We studied 71 patients with 12-hour Holter monitoring to determine if the incidence and complexity of ventricular arrhythmias in symptomatic coronary artery disease patients were related to the extent of left ventricular dysfunction. Their average age was 51 years, and each had cardiac catheterization within 3 months of study. Thirty-six patients had left ventricular aneurysms, 10 had normal left ventricular angiograms and 25 had left ventricular hypokinesis or akinesis without dyskinesis. The patients with aneurysms had significantly more heart failure, prior infarction, cardiomegaly and impaired ejection fractions. The mean premature ventricular contractions per hour for the aneurysm patients was 34 +/- 52, 3 +/- 5 for those with normal left ventricles, and 11 +/- 24 in the remainder. Complex premature ventricular contraction were noted in 50% of the aneurysm patients, in 10% of the patients with normal left ventricles and in 23% of the patients with hypokinesis or akinesis. Ventricular arrhythmias increase with greater left ventricular wall motion abnormality in patients with symptomatic coronary artery disease.