ABSTRACT
The huge growth in our understanding of the biology of the heart and the circulation has opened a vast number of ways to intervene in the pathophysiological processes related to arrhythmias at the cellular, molecular, and genetic level. Only careful study will show which of these many new approaches will be safe and successful. But I do not propose to offer here an encyclopedic tabulation of all possible ideas for intervention in the natural history of arrhythmogenic diseases. The chapters in this arrhythmia section and in the entire book already eloquently present many choices, and I do not have a crystal ball for divining which is the antiarrhythmic magic bullet. The unique contribution I may be able to bring to the discussion is a perspective or viewpoint, derived from a lifetime of struggle against the forces of sudden cardiac death. This has led me to a series of conclusions or lessons, derived from mistakes that we in the field have made. After defining the nature of the lethal arrhythmia problem, I propose to draw on the past to explain these conclusions, and then provide an example that illustrates a provocative and promising approach to arrhythmia prevention in heart failure.
