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  lüll Contemporary pacemakers: what the primary care physician needs to know Kaszala K; Huizar JF; Ellenbogen KAMayo Clin Proc  2008[Oct]; 83 (10): 1170-86Pacemaker therapy is most commonly initiated because of symptomatic bradycardia,  usually resulting from sinus node disease. Randomized multicenter trials  assessing the relative benefits of different pacing modes have made possible an  evidence-based approach to the treatment of bradyarrhythmias. During the past  several decades, major advances in technology and in our understanding of cardiac  pathophysiology have led to the development of new pacing techniques for the  treatment of heart failure in the absence of bradycardia. Left ventricular or  biventricular pacing may improve symptoms of heart failure and objective  measurements of left ventricular systolic dysfunction by resynchronizing cardiac  contraction. However, emerging clinical data suggest that long-term right  ventricular apical pacing may have harmful effects. As the complexity of cardiac  pacing devices continues to grow, physicians need to have a basic understanding  of device indications, device function, and common problems encountered by  patients with devices in the medical and home environment.|*Pacemaker, Artificial[MESH]|Bradycardia/*therapy[MESH]|Cardiac Pacing, Artificial/*methods[MESH]|Clinical Competence[MESH]|Equipment Design[MESH]|Humans[MESH]|Physicians, Family[MESH] |