Cardiac pacemakers can be life-perpetuating, perhaps fulfilling devices for those patients with symptoms due to heart block and various arrythmias. The efficacy of cardiac pacemakers is a function of their electrophysiologic effectiveness and the physical, psychological, and social resources of the individual. In 60 patients, ages 34 to 91, median 72 years, with permanent pacemakers (50 transvenous and 10 transthoracic) implanted for 4 years to 2 months determinations have been made of personality type, mental status, coping ability, object relations, and adjustment to previous prosthesis (eyeglasses, dentures, hearing aids) along with cardiovascular status and ancillary disease, for correlation with reactions