Updating guidelines issued in 2002, new recommendations provide comprehensive, evidence-based guidelines for the use of pacemakers, implantable cardioverter defibrillators, and all other electronic cardiac devices. Recently issued by the American College of Cardiology (ACC), the American Heart Association (AHA), and the Heart Rhythm Society (HRS), the guidelines are also the first to combine indications for all cardiac implantable devices and to address device-based therapy indications for various life-threatening cardiac conditions, including heart failure and congenital heart disease. For example, the guidelines clarify indications for cardiac resynchronization therapy and recommend that it be reserved for patients with heart failure who still have symptoms despite optimal medical therapy. The guidelines are expected to continue evolving as technology advances. You can find The ACC/AHA/HRS 2008 Guidelines for Device-based Therapy of Cardiac Rhythm Abnormalities online at http://www.acc.org, http://www.americanheart.org, and http://www.HRSonline.org.