LAUSR

Permanent cardiac pacemakers have been standard therapy for bradycardia and conduction disturbances for more than six decades. Since the first pacemaker implantation in 1958, on-demand dual chamber pacing and algorithms to optimise atrioventricular synchrony and promote intrinsic conduction have been developed, cardiac resynchronisation has been introduced, and completely leadless systems have been implanted in the right ventricle—most often in the right ventricular apex. However, chronic right ventricular apical pacing results in cardiac dyssynchrony, which may lead to pacing-induced heart failure, particularly in patients with diminished left ventricular function [1]. Although algorithms to reduce right ventricular apical pacing are available and alternative pacing sites, including right interventricular septum and right ventricular outflow tract, have been proposed, clinical evidence of their superiority over left ventricular apical pacing in patients with preserved left ventricular function has not been established [2]. This has led to the introduction of conduction system pacing: pacing from the His bundle or left bundle branch (LBB) to maintain the normal ventricular activation sequence and prevent pacing-induced heart failure. In this issue of the Netherlands Heart Journal, which is dedicated to electrophysiology in Dutch clinical practice, Heckman and colleagues describe their investigation of the feasibility and the learning curve of LBB area (LBBA) pacing [3]. LBBA capture was diagnosed when decreasing pacing output resulted in