This article reviews recent studies, chapters, and review articles describing advances in cardiac pacing. Initially we discuss expanding and controversial pacing indications, including neurocardiogenic syncope and hypertrophic as well as dilated cardiomyopathies. Recent contributions to the understanding of factors influencing pacing mode selection are then discussed, including survival and atrial fibrillation in the various modes, the hemodynamic importance of atrioventricular synchrony and adaptive atrioventricular intervals, the importance of rate adaptation, the development of pacemaker syndrome, pacemaker response to the development of atrial arrhythmias, and special pacing modes such as VDD and AAIR. Finally, recent advances in rate-adaptive sensors and algorithms are reviewed, including preliminary results with dual sensors.