Antiarrhythmic agents play an important role in the management of cardiac arrhythmias as both primary and hybrid therapy. The essential goals of antiarrhythmic therapy are termination of an ongoing arrhythmia, prevention of arrhythmia recurrence, or both. Antiarrhythmic drugs help control arrhythmias but also may cause them. Therefore, selection of an effective yet safe medication may be challenging. The challenge arises from factors intrinsic to the patient, the disease condition, or the drug itself. These factors include variability in the pathophysiologic substrate, arrhythmia mechanisms, clinical presentation, prognostic implications, drug disposition, and response. Patients with arrhythmia comprise a highly heterogeneous patient population, with variable comorbid conditions and concomitant drug use.