This study examines the relationship of hourly spectral measures of heart rate variability (HRV) to the occurrence of ventricular ectopic (VE) activity in 20 patients with idiopathic ventricular tachycardia and frequent VE's. Spectral measures of HRV were obtained from 24-hour Holter recordings from the patients in a drug free state and included the total energies in the spectrum, the low frequency components (L) (0.04-0.15 Hz) representing predominantly sympathetic tone with some contribution from the parasympathetic and high frequency components (H) (0.15-0.4 Hz) representing mainly parasympathetic tone. A high H component (parasympathetic) was defined as area > 12 msec and high L components (sympathetic) as area > 30 msec. On an hourly analysis of spectral components in relation to VE activity, VE's occurred significantly more frequently during periods of low H and low L (F = 20.5, DF = 3, P < 0.0001). The number of VE's did not differ statistically in the other combinations of H and L components (low H, low L = 612.8 (50.1); high H, low L = 180.1 (36.8); low H, high L = 338.4 (58.9); high H, high L = 204.9 (17.7) VE's/hr (SEM). The results suggest that VE's are more frequent during periods of low H and low L and are diminished when either H or L are increased in patients with idiopathic ventricular tachycardia. The results would be consistent with the hypothesis that the parasympathetic nervous system has an electrophysiologically stabilizing effect on the myocardium.