Drug-induced arrhythmias and sudden cardiac death: implications for the pharmaceutical industry

Following a series of high profile withdrawals from the market, the ability of medications to induce potentially fatal arrhythmias is a significant problem facing the pharmaceutical industry. Current preclinical cardiac safety assays are based on the assumption that blockade of a single repolarizing K(+) channel alone precipitates drug-induced arrhythmias, however, current findings point to a range of more complex arrhythmogenic mechanisms. This review begins by exploring clinical findings and potential mechanisms underlying drug-induced sudden cardiac death and then goes on to assess current and explore future strategies to detect cardiotoxicity at the preclinical stage.