Pacing of the specialized His Purkinje conduction system: ‘HOW and FOR WHOM’

The human heart’s conduction system consists of specialized cardiomyocytes that generate and transmit electrical impulses, leading to the rhythmic and synchronized contraction of the atria and ventricles, which is crucial for the normal cardiac cycle. In conduction system pacing (CSP), pacing leads are placed in the His bundle region and the left bundle branch area to achieve physiological cardiac activation. This method offers a more natural alternative to the myocardial stimulation provided by conventional right ventricular pacing and biventricular pacing. In this review, we describe the implantation techniques for CSP and discuss the current recommendations for their use.