The most common candidates for permanent pacemaker placement have symptomatic bradycardia, either in the form of sinus bradycardia or a third-degree AV block. Additional indications include chronic heart failure, heart disease, or carotid sinus syndrome resulting in episodes of syncope. The benefits must outweigh the risks in order for a permanent pacemaker to be recommended, and these risks and benefits must be clearly communicated to the patient when possible.