Conduction system pacing (CSP) has emerged as a more physiological alternative to right ventricular pacing and is also being used in selected cases for cardiac resynchronization therapy. His bundle pacing was first introduced over two decades ago and its use has risen over the last five years with the advent of tools which have facilitated implantation. Left bundle branch area pacing is more recent but its adoption is growing fast due to a wider target area and excellent electrical parameters. Nevertheless, as with any intervention, proper technique is a prerequisite for safe and effective delivery of therapy. This document aims to standardize the procedure and to provide a framework for physicians who wish to start CSP implantation, or who wish to improve their technique.

1st Department of Cardiology and Electrocardiology and Arterial Hypertension Jagiellonian University Kopernika 17 31 501 Kraków Poland

Arrhythmia and Electrophysiology Unit Santa Maria della Misericordia General Hospital Viale Tre Martiri 140 45100 Rovigo Italy

Bethel Clinic Burgsteig 13 33617 Bielefeld Germany

Brigham and Women's Hospital 75 Francis St Boston MA 02115 USA

Cardiac Pacing Unit Cardiology Department University Hospital of Geneva Rue Gabrielle Perret Gentil 4 1211 Geneva 14 Switzerland

Cardiocenter 3rd Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Ruská 87 100 00 Prague 10 Czech Republic

Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares Av Monforte de Lemos 3 5 Pabellón 11 Planta 0 28029 Madrid Spain

Department of Cardiology Cardiovascular Research Institute Maastricht Maastricht University Medical Center Universiteitssingel 50 6229 Maastricht the Netherlands

Department of Medicine McGill University Health Center 1001 Decarie Boulevard H4A 3J1 Montreal Canada

Geisinger Wyoming Valley Medical Center 1000 East Mountain Blvd Wilkes Barre PA 18711 USA

Heart Centre University Hospital Ghent Corneel Heymanslaan 10 9000 Gent Belgium

Hospital Universitario y Politecnico La Fe Avinguda de Fernando Abril Martorell 106 46026 Valencia Spain

National Heart and Lung Institute Imperial College London Guy Scadding Building Dovehouse St London SW3 6LY UK

The 1st Affiliated Hospital of Wenzhou Medical University Nanbaixiang Wenzhou 325000 China

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