Prevention of sudden cardiac death after myocardial infarction (MI) has become a continuing challenge for clinical cardiology. Of the many treatment modalities available, some have been shown to save lives while others may even have deleterious effects. Further survival studies exploring the efficacy of prophylactic treatment will be necessary before conclusions for routine clinical practice can be drawn. For this purpose, improvements in the process of risk stratification must be made before these studies are able to demonstrate potential survival benefit. This article will review both the established and the new methods of risk stratification for the post MI patient, with particular attention to antiarrhythmic therapy.