1. Introduction
Conduction system pacing (CSP) was a subject of intense discussion at the European Society of Cardiology (ESC) Congress 2021 due to an ever-growing interest in the past five years, both in the literature and clinical practice.1 This is because of the deeply established knowledge that chronic conventional right ventricular (RV) pacing is responsible for an increased risk of provoking and worsening heart failure with hospitalizations, as also atrial fibrillation or even causing death.2 The fact that conventional RV apical pacing (RVA pacing), through inter-ventricular dyssynchrony, promotes the appearance rather sooner than later of Pacing-Induced Cardiomyopathy makes it responsible for the disturbance of the diastolic and systolic function of both right and left ventricle, with the subsequent adverse impact on patients. (Figure 1 )
For the prevention of this phenomenon, alternative pacing strategies and sites have been proposed. On the one hand, pacing different areas of the myocardium outside the apex of the RV (non-apical RV pacing) by targeting the interventricular septum at various higher positions, such as this happens with the Right Ventricular Outflow Tract (RVOT) septal pacing, the Mid and High RV Septal (RVS) pacing, but also Para-Hisian pacing, and from the other attempt pacing parts of the conduction system (Conduction System Pacing - CSP), as with Left Bundle Branch Area pacing (LV Septal pacing or Left Bundle Branch pacing), but also His Bundle pacing (HBP). (Figure 2 )