The conduction system of the human heart is composed of specialized cardiomyocytes that initiate and propagate the electric impulse with consequent rhythmic and synchronized contraction of the atria and ventricles, resulting in the normal cardiac cycle. Although the His-Purkinje system (HPS) was already described more than a century ago, there has been a recent resurgence of conduction system pacing (CSP), where pacing leads are positioned in the His bundle region and left bundle branch area to provide physiological cardiac activation as alternatives to the unnatural myocardial stimulation obtained with conventional right ventricular and biventricular pacing. In this review, we describe the fundamental anatomical and pathophysiological aspects of the specialized HPS along with the CSP technique's nuts and bolts to highlight its potential benefits in everyday clinical practice.

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

Department of Cardiology Cardiocenter 3rd Faculty of Medicine Charles University University Hospital Kralovske Vinohrady Ruská 2411 100 00 Prague 10 Vinohrady Czech Republic

Department of Cardiology Cardiovascular Research Institute Maastricht Maastricht University Medical Center P Debyelaan 25 6229 HX Maastricht The Netherlands

Department of Cardiovascular Sciences Policlinico Casilino of Rome Via Casilina 1049 00169 Rome Italy

Unidad de Arritmias Departamento de Cardiología Hospital Universitario Quirón Salud Madrid and Complejo Hospitalario Ruber Juan Bravo Universidad Europea de Madrid Calle de Juan Bravo 49 28006 Madrid Spain

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