Many of the indications for cardiac pacing have evolved based on experience without the benefit of comparative, randomized clinical trials. The committee of the American College of Cardiology(ACC) and the American Heart Association(AHA) have jointly engaged in the production of the guidelines for implantation of cardiac pacemakers and antiarrhythmic devices in 1998. This guideline updates the previous versions published in 1984 and 1991. The recommendations listed in this guideline are, whenever possible, evidence based. The decisions regarding the need for a pacemaker are importantly influenced by the presence or absence of symptoms directly attributable to bradycardia. According to these new guidelines, we described the indications for permanent pacing, the choice of pacemaker generator and pacemaker follow-up in this issue.