Therapeutic, device-aided cardiac rhythm management is useful in patients with a variety of rhythm- and rate-related abnormalities, leading to reduction of symptoms of cardiac dysfunction and improvement in quality of life. Single-chamber atrial pacing has been commonly utilized in the treatment of patients with sinus pauses, sick sinus syndrome (sinus node dysfunction), and bradycardia–tachycardia syndrome. As long as AV (atrioventricular) synchrony is maintained and there is no AV block, this method has been noted to be efficacious and safe. If AV block does develop, atrial pacing will not prevent bradycardia. In such cases, ventricular pacing would be required as part of dual chamber pacing (i.e., atrioventricular pacing) or as standalone ventricular pacing. For prevention of atrial fibrillation, dual-site atrial pacing has been shown to be valuable as an adjunct to drug therapy in reducing the incidence of paroxysmal atrial fibrillation.

Single-chamber ventricular pacing has been utilized in patients with high-grade AV block, Mobitz type II, or third-degree heart block. It is usually reserved for patients who are not candidates for dual chamber AV pacing due to other comorbid factors that significantly reduce life expectancy or physical abilities. A major limiting factor for the utilization of this method is the occasional development of pacemaker syndrome, which occurs due to retrograde electrical current conduction through the AV node to the atria. This syndrome causes discordant premature contraction of the atria during the closed phase of the AV valve, with resultant decreased cardiac output. Weakness, dizziness, or even frank syncope are symptoms of this condition.