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The most recent American College of Cardiology Foundation/American Heart Association/Heart Rhythm Society(ACCF/AHA/HRS) guidelines related to pacemaker implantation were published as part of a larger document related to device-based therapy (1). While this document provides some comments on pacemaker mode selection and algorithms to guide selection, it does not provide specific recommendations regarding choices for single- or dual-chamber devices. Over the past 15 years multiple randomized trials have compared a number of cardiovascular outcomes among patients randomized to atrial or dual-chamber pacing vs. those randomized to ventricular pacing. The purpose of this 2012 consensus statement is to provide a state-of-the-art review of the field and to report the recommendations of a consensus writing group, convened by HRS and ACCF, on pacemaker device and mode selection. This document focuses on pacemaker device and mode selection in the adult patient; therefore, many of the  recommendations may not be applicable to unique situations encountered in the pediatric population. These recommendations summarize the opinion of the consensus writing group, based on an extensive literature review as well as their own experience.