Abstract
Antiarrhythmic therapy was first started with drug therapy. However, the CAST （cardiac arrhythmia suppression trial） study revealed that antiarrhythmic agents had a proarrhythmic effect on patients with asymptomatic ventricular premature beats, and increased the risk of death from arrhythmias. The use antiarrhythmic medications were modified from an empirical to scientific use after the Sicilian Gambit study. Radiofrequency catheter ablation was started in about the same era. It widely spread throughout the world, together with the progression of the technology of 3D mapping systems. Also, device therapies such as implantable cardioverter defibrillators, and cardiac resynchronization therapy have become available and contributed to the prevention of sudden cardiac death.Another issue to note is the advancement of genetic screening for inherited arrhythmias. Many gene anomalies have been found in long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, short QT syndrome, progressive cardiac conduction defects, familial sick sinus syndrome, and familial atrial fibrillation. From these gene analyses, the affected channels can be defined, and specific effective medications can be selected.
