A wide range of cardiac etiologies give rise to sudden cardiac death (SCD), the commonest being coronary artery disease, cardiomyopathy, and inherited arrhythmogenic disorders. Improved primary and secondary preventive pharmacotherapy, device therapy, lifestyle changes, and genetic profiling have had a major impact on the prediction and prevention of SCD. By far the best preventive strategy is to inhibit the development of electrophysiological substrates giving rise to ventricular tachyarrhythmias. A significant role in this regard has been played by nonantiarrhythmic drug therapy designed to avoid and reverse substrate remodeling and inappropriate substrate modulation by the autonomic nervous system. Improved resuscitation and defibrillation techniques, together with advances in implantable pacemaker and defibrillator technology, have all improved treatment outcome. Much recent research has been directed at profiling patients most likely to benefit from implantable cardioverter defibrillator therapy. Early experience with new safer and more specific antiarrhythmic pharmacotherapy has already shown benefits. Although SCD can now be effectively predicted, prevented, and treated, the burden of cardiovascular disease is rising again, making the availability of cost-effective therapy for life-threatening ventricular arrhythmias an increasingly significant challenge.