Evolving Indications for Permanent Pacemakers

New indications for permanent cardiac pacing have been devel-oped in recent years, with numerous studies demonstrating im-proved clinical outcomes in a variety of disorders. Because hyper-trophic obstructive cardiomyopathy, dilated cardiomyopathy, heart failure, neurocardiogenic syncope, and atrial fibrillation are com-mon conditions, every clinician should be aware of evolving alternative therapies for them. Observational studies in patients with refractory, symptom-atic hypertrophic obstructive cardiomyopathy and significant left ventricular outflow gradient at rest suggest that cardiac pacing may result in symptomatic and hemodynamic improvement. Clin-ical trials have not shown conclusive evidence regarding the long-term benefit from pacing in these patients, and it is unclear whether pacing will be a preferred treatment option. Preliminary data suggest that pacing is a viable adjunctive therapeutic ap