Medico S.p.A. was established in 1973 and is still a privately owned and independent firm. For more than 30 years we have been working in cardiac stimulation with the aim to guarantee to physicians and patients a high technology standard. The pioneering spirit of the Company in the development of new technologies has been shown since the 80s, when Medico revolutionized the stimulation practice with the introduction of single-lead VDD pacing with 3 cm atrial floating dipole. With the ambition to give to the physicians the suitable tools to optimize the therapy for every single patient, in the recent years the firm has been devoted to the development of an integrated system for the measurement of TVI (Trans Valvular Impedance), an impedance signal derived between right atrium and ventricle by means of standard pacing electrodes. This signal can provide important information about the mechanical function of the heart. In particular, it is possible to detect changes in preload and stroke volume, in order to monitor the hemodynamic stability along the time. This innovative system is available in all pacemakers of the Sophòs and Helios families and provides a continuous feedback on device programming and pharmacological therapy effectiveness. Other applications based on TVI include ejection checking after ventricular pacing (with algorithms for automatic adjustment of pacing energy) and sensing (safety pacing is delivered if ventricular oversensing is suspected).