In the course of the past 25 years the indication for pacemaker implantation has changed from AV-block to the sick sinus syndrome in about 40% of patients. In the same period pacemaker technology has developed considerably and today there are, in addition to the ventricular inhibited pacemaker, two-chamber systems (essentially DDD pacemakers) and pacemakers with an increasing pulse rate during physical effort. The new nomenclature, mode of action and hemodynamic implications of the various systems are explained, and recommendations for implantation are given.
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