A worldwide cardiac pacing and ICD survey was undertaken for calendar year 2001. Fifty countries, 22 from Europe, 16 from the Asia Pacific region, 3 from the Middle East and Africa, and 9 from the Americas contributed to the survey. The United States had by far the largest number of cardiac pacemaker implants, although Germany had the highest new implants per million population. Virtually all countries that participated in the 1997 survey showed significant increases in implant numbers over the 4 years. High degree atrioventricular block and sick sinus syndrome remain the major indications for implantation of a cardiac pacemaker with < 2% biventricular pacing in those countries that implanted such systems in 2001. There remains a high percentage of VVIR pacing in the developing countries with only a few countries using substantial numbers of single lead VDD and AAIR systems. There has been an increase in the use of DDDR systems in most countries since the 1997 survey. Pacing leads were predominantly transvenous, bipolar, and passive fixation. There was an increased use of active-fixation leads in the atrium. There was a significant rise in the use of ICDs with the largest usage occurring in the United States. A group of enthusiastic survey coordinators has now been established. Recruitment of new countries will hopefully continue to obtain a fully global experience of cardiac pacing and ICD usage.