Heart rhythm disorders (cardiac arrhythmias) are a common cause of death and disability, affecting millions of individuals worldwide. More than half of sudden cardiac deaths are attributed to ventricular arrhythmias and atrial fibrillation, with the latter being the most prevalent clinical arrhythmia affecting >30 million individuals worldwide. Cardiac arrhythmias result from abnormal electrical impulse formation in cardiomyocytes or impaired electrical conduction between cardiac cells. Despite significant advances and increasing prominence of non-pharmacological antiarrhythmic therapies, including catheter ablation and cardiovascular implantable electronic devices, pharmacological therapy with antiarrhythmic drugs (AADs) remains a cornerstone for the management of cardiac arrhythmias. AADs aim to restore and/or maintain normal sinus rhythm by modulating cardiac electrophysiological properties, typically by inhibiting one or more types of cardiac ion channels. This article summarizes fundamental arrhythmia mechanisms and principles of anti-arrhythmic therapies, including a historical overview of AADs, their classification, contemporary use and proarrhythmic side effects. Thereafter, the major properties of commonly used AADs are presented. Finally, future perspectives for cardiac arrhythmia management, including novel drug targets, alternative forms of drug administration and opportunities for personalized therapy are briefly discussed.