Physiologic pacing is an evolving term used to describe different concepts and technologic developments in implantable devices (including pacemakers and defibrillators) over the past several decades. Currently much of the discussion about optimal physiologic pacing involves fairly recently appreciated deleterious effects of traditional right ventricular pacing. Technologic solutions to the goal of avoiding unnecessary ventricular pacing appear to be available and successful. Although much work is being done to find more physiologic ways to pace the ventricles when necessary, the solutions for this goal are less clear.