Antiarrhythmic drugs: rethinking targets, development strategies, and evaluation tools

Although antiarrhythmic drugs have the potential to save lives, current approaches to drug selection and development preclude exploitation of the full potential of such agents. It is therefore important that we reconsider the identity and nature of the target sites of such drugs and the strategies used in their development. The concept of a vulnerable parameter as a factor contributing to arrhythmogenesis, amenable to modulation by drugs or other interventions, has helped conceptualize the targeted approach to both drug discovery and drug selection. Moreover, broadening our perspectives to include both the triggers of and substrates for arrhythmias widens the scope of promising targets for drug development programs.