New insights into a personalized approach to conduction system pacing

Since the reporting of the first case of left bundle branch pacing (LBBP) in 2017,1 it has rapidly developed into a promising pacing technique. Increasing evidence has demonstrated its feasibility, safety, and clinical benefits, while ongoing clinical trials will more clearly show its role compared to currently available pacing modalities. Unlike His bundle pacing, the relatively large network of interlacing Purkinje fibers and abundant connections with the left ventricular (LV) endocardial myocardium result in a series of surface electrocardiographic (ECG) changes during LBBP implantation, which makes it difficult to confirm whether the conduction system is being successfully captured.