This study illustrates the marked increase in implantation rate which is a reflection of the significant increase in referrals to the Critical Care Department and the profound shift to more physiological and sophisticated pacemakers as a result of the increased awareness of haemodynamic benefits and better quality of life with those pacemakers. The use of permanent pacing in non bradycardia indication is showing a progressive though slowly rising contribution. Lastly pacemaker related side effects still represent a dreadful complication despite the growed experience of the Critical Care Team over twenty years of pacing.