[Selection of pacemaker stimulation mode]

Permanent cardiac pacing is a widely recognized therapy used for the treatment of several types of bradycardia, atrioventricular (AV) block and sinoatrial node disease mainly. In the beginning, implantable cardiac pacemakers stimulated just one cardiac chamber and right ventricule pacing were the most frequently used devices. In the 1980s, pacemaker's technology focus on restoring AV synchrony, named <> cardiac pacing, allowing the development of dual-chamber pacemakers (DDD, DDDR). Even though theoretical advantages of dual-chamber devices, its implantation is more complicated and expensive. For these reasons, the selection of the optimum mode of pacing is still controversial. Nowadays, available results from many trials that analyze clinical and physiological benefits of the different pacing modes, allow us to conclude that physiologic pacemakers reduce the risk of atrial fibrillation but do not improve survival and do not reduce the risk of stroke. By other hand, the reduction of pacemaker syndrome is not a constant finding in all the trials. In our clinical practice, when we have to select the pacing mode we have to take in account these results together with other factors as patient's characteristics (age, comorbility and life expectansy). Also, data from cost-effectiveness analysis should be added to the available information for the making decision.