The most common cause of cardiac side effects of pharmaco-therapy is acquired long QT syndrome, which is characterized by abnormal cardiac repolarization and most often caused by direct blockade of the cardiac potassium channel human ether a-go-go-related gene (hERG). However, little is known about therapeutic compounds that target ion channels other than hERG. We have discovered that arsenic trioxide (As 2 O 3 ), a very potent antineoplastic compound for the treatment of acute promyelocytic leukemia, is proarrhythmic via two separate mechanisms: a well characterized inhibition of hERG/I Kr trafficking and a poorly understood increase of cardiac calcium currents. We have analyzed the latter mechanism in the present study using biochemical and electrophysiological methods. We find that oxidative inactivation of the lipid phosphatase PTEN by As 2 O 3 enhances cardiac calcium currents in the therapeutic concentration range via a PI3K␣-dependent increase in phosphatidylinositol 3,4,5-triphosphate (PIP 3 ) production. In guinea pig ventricular myocytes, even a modest reduction in PTEN activity is sufficient to increase cellular PIP 3 levels. Under control conditions, PIP 3 levels are kept low by PTEN and do not affect calcium current amplitudes. Based on pharmacological experiments and intracellular infusion of PIP 3 , we propose that in guinea pig ventricular myocytes, PIP 3 regulates calcium currents independently of the protein kinase Akt along a pathway that includes a secondary oxidation-sensitive target. Overall, our report describes a novel form of acquired long QT syndrome where the target modified by As 2 O 3 is an intracellular signaling cascade.Combination therapy with As 2 O 3 and retinoic acid is so effective in the treatment of acute promyelocytic leukemia that it has the potential to become the standard of care in patients (1-3). Therapy with As 2 O 3 has also shown great promise in additional hematological malignancies and even solid tumors (4). Therefore, it is of the utmost importance to acknowledge that therapeutic use of As 2 O 3 can be complicated by cardiotoxicity, including a significant prolongation of the QT interval on the electrocardiogram and an increased propensity to develop torsades de pointes arrhythmias, which may degenerate into fatal ventricular fibrillation (5-7).Clinically, As 2 O 3 -induced QT prolongation and torsades de pointes arrhythmias are considered hallmarks for drug-induced or acquired long QT syndrome (acLQTS).2 In most instances, acLQTS is caused by a direct blockade of the cardiac potassium channel hERG/I Kr , which is crucial for terminal repolarization of the cardiac action potential (8). Importantly, this is not the case for As 2 O 3 -induced long QT syndrome. Instead, we have discovered that antineoplastic As 2 O 3 is proarrhythmic 1) by inhibition of hERG export to the cell surface via disruption of channel-chaperone interactions essential for hERG maturation and 2) by a fast increase in cardiac calcium currents (9). Just like hERG block or hERG trafficking inhib...