Evolving indications for permanent pacing

Indications for permanent pacemakers have expanded in recent years. The American College of Cardiology (ACC) and American Heart Association (AHA) guidelines for implantation of cardiac pacemakers were recently updated and now include several of the newer indications. Greatest interest about newer applications of pacemaker therapy focuses on hypertrophic obstructive cardiomyopathy, dilated cardiomyopathy, and pacing for the prevention of atrial fibrillation. Pacing for neurocardiogenic syncope remains controversial despite emerging data. Pacing for long QT syndrome, pacing after cardiac transplantation, and pacing for hemodynamic improvement in the occasional patient with first-degree atrioventricular block and hemodynamic compromise also warrant attention. Available clinical data are discussed in the context of the recent ACC and AHA guidelines.