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patients at high risk of symptomatic atrial fibrillation flutter generally patients who have had previous episodes of atrial fibrillation flutter that were so frequent and poorly tolerated as to outweigh in the judgment of the physician and the patient the risks of prophylactic therapy with quinidine gluconate the increased risk of death should specifically be considered quinidine gluconate should be used only after alternative measures e g use of other drugs to control the ventricular rate have been found to be inadequate in patients with histories of frequent symptomatic episodes of atrial fibrillation flutter the goal of therapy should be an increase in the average time between episodes in most patients the tachyarrhythmia will recur suppression of ventricular arrhythmias quinidine gluconate is also indicated for the suppression of recurrent documented ventricular arrhythmias such as sustained ventricular tachycardia that in the judgment of the physician are life threatening because 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