One of the few areas in clinical medicine which is more affected by advances in engineering technology is cardiac pacing. In about half a century since the first implantation of a pacing system, there has been a significant progress concerning the pacing devices and along with the growing number of new indications for pacing, this will lead to an increasing number of implanted devices over the following years. This fact will raise the possibilities for the new anaesthesiologist to manage a paced patient. Despite the remarkable progress, there is still the chance for adverse effects due to exposure to electromagnetic and mechanical interference. It is necessary to understand the indication for which the device was prescribed and how it is expected to react in such conditions. Another consideration is the knowledge to detect possible device malfunction, and the basic principles of their treatment. However, anaesthesiologists must recognize that this is a very complex and constantly evolving field of technology. It is strongly recommended that they make use of all the resources available to them for advice, regarding perioperative management issues. So that the perioperative management of the patient with cardiac rhythm devices will be beyond the common practice a really challenging experience.