Permanent cardiac pacing was introduced in 1958 and till the end of 70s this method saved lives in particular of the patients with advanced atrioventricular block. The implantation technique has changed from complicated thoracotomy to endovasal approaches. The introduction of physiological AV sequenced atrioventricular pacing marked a significant progress in this field. Acute haemodynamic studies documented positive effect of the atrial contribution. Numerous studies subsequently analyzed the influence of different pacing regimes on total and specific cardiovascular mortality and morbidity. It can be concluded that on the basis of present evidence-based medicine the use of physiological pacing is clearly indicated in the patients with expressed sinus bradycardia and AV block of a higher degree. Atrial pacing remains an ideal solution for the patients with isolated sinus node dysfunction and sufficient atrioventricular conduction capacity. Research is continued in order to clarify how to influence the occurrence of ventricular fibrillation by permanent cardiac pacing including the use of preventive algorithms. This topic has not yet been reliably and unambiguously concluded. Biventricular pacing is currently established and recognized not only for typical indications in cases of bradyarrhythmias but also to solve primary haemodynamic problems in the patients with advanced heart failure and evidence of ventricular dyssynchrony.