Definitive cardiac stimulation ralatually used for brady cardia are going to be in the third millennium the specific therapy of arrhythmia and cardiomyopathy. In the last 10 years, may progress occur in the use of cardiac stimulation as hemodynamic therapy of obstructions hypertrophic and dilated cardiomyopathies resistant to conventional medical treatment. Moreover auricular stimulation present antiarrhythmic effects in some atrial arrhythmias as auricular fibrillations auricular diseases and atypical flutters. It confirmed by prospective multicentric randomized trials cardiac stimulation may represent in the future a good physiopathologic and efficient treatment free from the side effects of drugs that remain partially active. These perspectives needs to be modulated by the known and acceptable risks of a definitive cardiac stimulation.