Why pacing of conduction system?

Cardiac pacing since the 50th of the last century is the standard of care for patients with bradycardia. The aims of this therapy have changed over the decades from a life-saving option to achieve the most physiologic “prosthesis” of the conduction system in patients with atrioventricular blocks and improve depolarization sequence in those with heart failure and intraventricular conduction abnormalities. In the last years, direct conduction system pacing methods are developing very quickly. His bundle pacing, direct left bundle branch pacing with its modifications were introduced into clinical practice. Lack of big, randomized trials and technical aspects of these new modes of pacing caused that these methods haven’t achieved a high class of recommendation in recently published guidelines of the European Society of Cardiology.