Conduction system pacing: What is new in 2025 Clinical Consensus Statement

Conduction system pacing (CSP), which includes His bundle pacing (HBP) and left bundle branch area pacing (LBBAP), is
increasingly recognized as a physiological and clinically effective alternative to conventional right ventricular pacing
(RVP) and biventricular pacing (BiVP). The 2023 EHRA consensus provided a detailed overview of implantation
techniques and procedural endpoints, while the 2025 EHRA/ESC clinical consensus expands the discussion to clinical
decision-making and patient selection across various scenarios.
This review highlights the evolving role of CSP specifically in the context of bradycardia management and cardiac
resynchronization therapy (CRT). We focus on how recent recommendations guide the choice of pacing strategy or
resynchronization modality depending on individual clinical scenarios.