The automated measurement of the main electrical parameters of pacemakers, such as battery voltage, current drain, pacing impedance, sensing levels, and pacing thresholds enables a continuous monitoring of the adequate functioning of the implanted device. New technologies in device interrogation, data transfer, and patient alert functions will enhance therapy safety significantly by the immediate detection of all, including transient, device malfunctions. The introduction of this technology will result in major changes in follow-up of patients with pacemakers. Technically we are very close to the goal of a fully automated pacemaker, although clinical acceptance lags behind. Clinical studies are necessary to demonstrate the beneficial effects of automated device functions, with regard to the main rationales for pacemaker automatization: increased patient safety, improved quality of life, and an improvement in the cost-benefit ratio in pacemaker therapy.