During the last 50 years a continuous improvement was observed in the field of cardiac pacing and electrophysiology as for as both technological and clinical aspects were concerned. We moved from the first recording of the His bundle electrogram to the identification of the various mechanisms and sites of supraventricular and ventricular tachyarrhythmias, to three-dimensional mapping and ablation of different reentry circuits and eventually to pulmonary vein isolation for the treatment of atrial fibrillation. As far as cardiac pacing is concerned, we moved from single chamber to dual chamber pacing, to ventricular pacing and implantable automatic defibrillators provided by sophisticated diagnostic and therapeutic algorithms and by remote control. Recently a family of leadless devices (loop recorders, endocavitary pacemakers, subcutaneous defibrillators) have become available for diagnostic and therapeutic purposes and brought a significant benefit in the reduction and management of many device-related troubles.