EDITORIAL Physiological pacing: a moving target?

This editorial refers to ‘Long-term clinical effects of ventricular pacing reduction with a changeover mode to minimize ventricular pacing in a general pacemaker population’†, by M. Stockburger et al., on page 151 During the 1990s and the early years of the 2000s, there was consid-erable debate on the advantages of ‘physiological ’ pacing, which at that time denoted dual-chamber vs. single-chamber pacing. A series of landmark studies, including the MOST, PASE, CTOPP, and UKPACE trials, randomized patients with various indications for pacing into DDD vs. VVI pacing modes. Despite high hopes and great belief in the advantages of ‘physiological ’ pacing, these studies demonstrated only a modest advantage of the ‘physiological ’ ap-proach, expressed by a reduction of atrial fibrillation (AF), mostly limited to patients with sinus node disease (SND) indication for pacing.