Abstract The past, present, and future development of cardiac pacing results from an intricate symbiosis between engineering and medicine. To gain an in-depth understanding of the field and perhaps where future innovation may lead, it is important to learn valuable lessons from past innovators. This chapter dives into the rich history surrounding the field of cardiac pacing. In addition, it describes the current technology standards, discusses different pacing paradigms, and offers a glimpse into the bright future of cardiac pacemaker therapy.