Opinion has oscillated in the cardiology community regarding the significance of ventricular premature beats and non-sustained ventricular tachycardia as predictors of sudden cardiac death. Automaticity can be a marker of underlying structural heart disease. It is unclear whether the apparent association with sudden death is simply a reflection of this fact. Older data are unreliable as the populations studied probably had a high prevalence of unrecognized structural heart disease. Current risk stratification is imperfect. The balance of evidence suggests that automaticity does predict risk and it may have a role in risk-assessment algorithms, but at present the dataset is insufficient.