His-Purkinje conduction system pacing

His bundle pacing is performed at our centre since 2017 and has been adopted in tertiary centres accross Switzerland. It provides true physiological stimulation, thereby avoiding avoiding the detrimental effects of right ventricular pacing. However, relatively high incidences of lead revision and increases in capture thresholds have been reported. An alternative technique, practiced at our centre since 2020, is left bundle area pacing, which provides excellent electrical parameters. However, long-term data on lead performance and extractibility are lacking. Furthermore, although these techniques are conceptually very attractive, there is a dire need for studies randomizing conduction system pacing with right ventricular / biventricular pacing, before they can be considered as becoming the gold standard.