On the reasonable (but unproven) assumption that sudden death in congestive heart failure (CHF) is primarily due to arrhythmia, four management strategies are employed: (i) treatment to prevent reversible causes of arrhythmia; (ii) ß-blockade and angio-tensinconverting enzyme inhibition (included in strategy 1, but directly useful by inhibiting sympathetic– renin-angiotensin activation, a common maladaptive response in CHF); (iii) antiarrhythmic drugs (in selected cases, eg, amiodarone to maintain sinus rhythm after conversion of atrial fibrillation; and (iv) an implanted cardioverterdefibrillator device, an increasingly valid option in high-risk patients. New approaches may be genebased, such as the discovery of an association between arrhythmia and reduced Kv4.3 gene expression. Continuing application of molecular techniques will identify further instances of altered gene expression in CHF and new therapeutic options...