Data are slowly accumulating regarding the possible benefits and appropriate uses of permanent cardiac pacing in a variety of pathophysiologic states or syndromes other than the broad categories and indications of sinus node dysfunction and atrioventricular block. The subjective and physiologic indications for pacing in these disorders are not symptomatic bradycardia or fulfillment of previously accepted criteria for antibradycardia pacing, and pacing is not the first or only therapy used. Therefore, individual patient evaluation, often including documentation of the response to temporary pacing therapy prior to implantation of a permanent device, is helpful and may be necessary. Controversy regarding the data available, and expanding clinical use of permanent cardiac pacing in a number of these conditions or syndromes, remains.