One of my patients, who has been experiencing frequent and sometimes somewhat frighteningly long intervals of cardiac arrest in the recent phase, should have been fitted with a pacemaker according to common sense. As a matter of prudence, he was asked to undergo an esophageal pacing test, which revealed that there was no cardiac commander failure and that a pacemaker could be disregarded. After a combination of Chinese and Western medicine, there are now no more long intervals. During his hospitalization, it was found that his long intervals occurred mostly at night and were associated with continuous swallowing movements, so they were judged to be caused by increased vagal tone. When you notice that your pulse has long intervals, you should first check a 24-hour ambulatory electrocardiogram (also known as a Holter test) to first clarify the nature of the long intervals. If there are long intervals of more than 5 seconds, or if there are severe electrocardiographic manifestations of AV block, a pacemaker will be required in most cases. However, it is advisable to perform an esophageal pacing test before considering the installation of a pacemaker. Since the esophagus is close to the heart, it is possible to determine the need for a pacemaker by a very weak electrical stimulation signal and by certain regular changes in the stimulation. If the sinus node, the heart’s commander, is completely damaged, if a pathological sinus node syndrome occurs, or if a severe arrhythmia with a very slow ventricular rate is present, a pacemaker should be installed. In the above-mentioned patient, no pacemaker was installed because all indicators of the esophageal pacing test were within the permissible limits.