In 1958, Dr. Furman implanted the world’s first pacemaker in a patient with complete AV block. This was a landmark treatment that ushered in a new era of implantable device therapy for cardiovascular disease, and cardiac pacing has become an effective treatment for patients with symptomatic bradycardia. Over the past 50 years, pacemakers have evolved from non-physiologic to physiologic pacing, especially in recent years, when the concept of physiologic pacing has undergone a landmark change. Pacemakers have evolved from a simple device that only delivers electrical impulses to stimulate the heart to provide life support from cardiac arrest, to a device that diagnoses, prevents, and treats bradyarrhythmias and tachyarrhythmias, and stores large amounts of information about arrhythmias, as well as treating other non-arrhythmic disorders. The new indications for pacemakers with certain therapeutic effects are mainly in the following areas. First, anti-atrial fibrillation cardiac pacing In the past, pacemaker implantation for the treatment of tachyarrhythmias, such as paroxysmal supraventricular tachycardia, atrial flutter and paroxysmal atrial fibrillation made many attempts, but with the development of radiofrequency ablation, the pacemaker is no longer preferred for simple anti-tachycardia and anti-atrial fibrillation. However, the 2008 guidelines developed by the AHA/ACC/HRS include bradycardia, symptomatic medically refractory paroxysmal atrial fibrillation as a class IIb pacing indication, but it is worth noting that symptomatic sick sinus syndrome, and paroxysmal atrial fibrillation should be a class I pacemaker indication. Anti-fibrillation pacemakers prevent atrial fibrillation by two methods, one is unconventional right atrial pacing, including right atrial multi-site pacing, bi-atrial synchronized pacing, and atrial septal pacing, etc., which reduces or prevents atrial fibrillation by mitigating local conduction delays, restoring bi-atrial synchronization, and decreasing the degree of repolarization dispersion and atrial anisotropy. Another principle of anti-fibrillation pacemaker is to use special algorithm (program), such as continuous dynamic overdrive atrial pacing, triggered by the basic principle of overdrive atrial pacing, which actually includes atrial priority pacing, overdrive pacing after mode conversion, overdrive inhibition after atrial pre-systole, prevention of sudden drop in frequency after exercise, and inhibition of atrial pre-systole to prevent or reduce the onset of atrial fibrillation. Pacing therapy for hypertrophic obstructive cardiomyopathy In patients with hypertrophic obstructive cardiomyopathy, the hypertrophied interventricular septum protrudes into the outflow tract during left ventricular contraction, and at the same time the anterior mitral leaflet of the mitral valve shifts forward due to the siphon effect (SAM phenomenon), which aggravates the obstruction of the left ventricular outflow tract, leading to a decrease in the amount of cardiac pulsatile blood, and thus generating the corresponding symptoms or signs. The basic principle of pacemaker implantation for the treatment of hypertrophic cardiomyopathy is to make the apical part of the right ventricle agitated first, artificially causing an effect similar to left bundle branch block, the right and left ventricles can not synchronize the contraction of the left ventricle, left ventricular outflow tract obstruction when the left ventricular contraction is alleviated, at the same time, siphon effect is reduced, coupled with the long-term apical part of the right ventricle pacing can lead to left ventricular remodeling, the cardiac cavity is enlarged, so as to alleviate the condition. Neurally mediated syncope pacing therapy Neurally mediated syncope is common in clinical practice, which is caused by excessive nerve reflexes that result in transient hypotension and bradycardia, which leads to syncope. 2004 European Society of Cardiology guideline, neurally mediated syncope is categorized as vasovagal syncope, carotid sinus syncope, situational syncope, and glossopharyngeal neuralgia, which cause transient bradycardia and hypotension during syncopal episodes, which leads to syncope. This in turn leads to syncope. The main indications for pacemaker therapy are vasovagal syncope and some carotid sinus syncope. Currently, pacemaker therapy for neurally mediated syncope is accomplished using a program of pacemaker frequency dips and frequency lags. Cardiac pacing can alleviate the patient’s lack of cardiac output due to a slow heart rate. Cardiac pacing is generally not the first choice of treatment for syncope, but for patients with cardioinhibitory and mixed vasovagal inhibitory syncope who cannot tolerate or are not on medication, implantation of a pacemaker for pacing therapy is an effective treatment method. Fourth, cardioverter defibrillator pacemaker (ICD) The cause of cardiac arrest in addition to cardiac arrest and ventricular tachycardia, ventricular fibrillation and other rapid ventricular arrhythmias, for the general pacemaker can not help, and the need for implantation of the ICD, which is the first to automatically identify and terminate potentially fatal arrhythmia device. 1980s, Mirowski introduced the ICD to the people for the first time, the people have also been skeptical of its efficacy of real. When Mirowski first introduced the ICD in the 1980s, people were skeptical about its efficacy. At the time, ICDs were a rarity; they were large, simple and unstable, and complicated and risky to test. With the increasing perfection of the manufacturing process and the affirmation of its efficacy in clinical trials, the ICD has been accepted by more and more doctors and patients, and its development speed greatly exceeds that of pacemakers. Today’s ICDs are very mature, and in addition to being able to terminate malignant tachyarrhythmias, they also have all of the functions of a modern pacemaker, which is the only effective treatment method for patients at risk of sudden death. V. Anti-heart failure pacemaker (CRT) Various myocardial lesions caused by systolic heart failure patients, about ≥ 40% with QRS time widening, suggesting that there are conduction disorders in the interventricular or intraventricular, resulting in intraventricular or interventricular contraction asynchrony, according to the clinical research observation of the QRS wave group of time limit of the normal patients with heart failure is also common in the phenomenon of biventricular dyssynchrony, which leads to the contraction of the right ventricle and the septal contraction. As a result, the right ventricle and septum contraction is advanced, the left ventricular free wall contraction is delayed, the two ventricles lose synchronized contraction function, part of the blood is retained in the ventricular cavity and can not be pumped out, the effective filling time in diastole is shortened, the left ventricular end-diastolic pressure rises, the ventricular wall tension is increased, and the left ventricular ejection fraction decreases. Left ventricular enlargement causes mitral regurgitation, and biventricular and left ventricular systolic desynchronization aggravates mitral regurgitation. Anti-failure pacemakers, implanting left ventricular pacing electrodes into the left ventricular lateral or posterior branch vessels of the coronary veins through the right atrial coronary venous sinus orifice, together with the right ventricular apical electrodes, receive impulses and stimulate the ventricular muscle in an almost synchronized manner to achieve synchronized contraction of the two chambers, reduce mitral regurgitation, and improve the left ventricular ejection fraction, which can alleviate the symptoms, improve the quality of life, and reduce the risk of death. The CARE-HF study proved that for NYHA class III-IV heart failure, the addition of biventricular synchronized pacing on top of standard drug therapy can reduce hospitalization rate by 37% and all-cause mortality rate by 36%. It can be said that ventricular synchronization is an important advancement in the treatment of heart failure, and implantation of an anti-heart failure pacemaker for ventricular synchronization should be the first choice for patients with indications for this treatment on the basis of drug therapy.