Since pacemakers first have been implanted in 1958 considerable technical progress has been achieved. The devices are more efficient today, have complex diagnostic functions, memory capacity and it is even possible to get telemetric software updates. Automatic mode switch due to changing heart rhythm, adaptation of AV-delay, auto sensing and auto stimulation threshold are available and facilitate pacemaker follow up. Because of continuously progress in pacing therapy guidelines have to be updated very often. The newest German and international guidelines for pacing therapy have been published in 2005 by Deutsche Gesellschaft für Kardiologie/ Herz- und Kreislaufforschung (DGK). Indications for pacing therapy increases continuously. Not only bradycardia, but also heart failure, prophylactic pacing to prevent and to terminate tachyarrhythmias are modern fields of pacing therapy.