Résumé
Efficient cardiac contraction depends on the sinus rhythm and cardiac synchronization. Arrhythmias, in particularly atrial fibrillation and ventricular tachycardia, are a major public health concern and represent a significant and increasing economic burden for healthcare systems aging. Arrhythmias resulted from cellular electrophysiological alteration to altered electrical impuls and conduction that could meet favoring substrates as cardiac remodeling, especially in the setting of underlying heart disease and accompanying autonomic dysfunction. Development of novel pharmacological antiarrhythmic compounds with high benefit and reduced side effects are need but since several decade, research and development office failed to propose new efficient molecules. Since Vaughan Williams classification to future strategies to understand, "ideal" molecules failed to be available despite the great advances of science, money and energy that were invested in this field of investigation. A review of the literature and a critical reflexion about the choice of the target of antiarrhythmic drugs in development was made. In particular, we focused on novel therapeutic approaches, based on recent advances in the understanding of cellular mechanisms arrhythmias and normalization of Ca2+ cycling. (C) 2011 Elsevier Masson SAS. All rights reserved.