Precision medicine in cardiac electrophysiology: where we are and where we need to go

Introduction The treatment of arrhythmias is complex and there are many options including drug therapy, ablation techniques, and implantable devices. Selection of the right treatment strategy is complicated by the fact that patients with apparently the same clinical picture may respond differently to a given therapy, indicating some underlying molecular and cellular differences. We now know this is mediated in a large part by the genetics, and patients with similar phenotypes may have differing genotypes. Understanding this genotype–phenotype relationship is key in modern medicine.Areas covered We have conducted an exhaustive review of the literature surrounding the genetic basis of arrhythmias and have presented a comprehensive summary of the available information. We have demonstrated how understanding the underlying genetic and molecular derangements in arrhythmias has resulted in effective targeted treatments. We have further highlighted novel therapies in arrhythmia management based on emerging genomic research.Expert opinion The future of cardiac electrophysiology, and indeed all cardiovascular medicine, lies in the development of targeted therapies that can effectively treat the individual patient, based on their specific genetic attributes and variations. Future genetic research which drives the development of innovative therapies holds the promise of delivering such personalized therapies in cardiac electrophysiology.