ESCEuropace(2023)25,1237-1248EHRA DOCUMENTEuropean Society https://doiorg/10.1093/europace/euad044of CardiologyEHRA clinical consensus statementon conduction system pacing implantation:executive summary.Endorsed by theAsia-Pacific Heart Rhythm Society (APHRS),Canadian Heart Rhythm Society (CHRS)andLatin-American Heart RhythmSociety (LAHRS)Haran Burri 1,Marek Jastrzebski?,Oscar Cano3,Karol Curila,Jan de Pooter5,Weijian Huang,Carsten Israel',Jacqueline Joza,Jorge Romero,Kevin Vernooy10,Pugazhendhi Vijayaraman1,Zachary Whinnett2,and Francesco Zanon3Cardiac Pacing Unit University Hospital of Geneva Geneva Switzerland:"Frst Department of Cardiology and Electrocardiology andArterial Hypertension.giellonianUniversity.Krakow.Poland:Hospital Universitario y Politecnico La Fe ValenciamSpain and Centro de Investigaciones Biomdicas en RED en Enfermedades Cardiovasculares (CIBERCV)Madrid,SpaincCardiocenter.Third Faculty of Medicine.Charles University and University Hospital Kralovske Vinohrady.Prague.Czech Republic Heart Centre.University Hospital Ghent.GhentBelgiumThe First Affiliated Hospital of Wenzhou Medical University.Wenzhou.China:Bethel-Oinic.Bielefeld,Germany:Department of Medicine McGill Universty Health CenterMontreal Canada:Brigham and Women's Hospital Boston Massachusetts,United States of America 10Department of Cardiology.Cardiovascular Research Institute Maastricht (CARIM)Maastricht University Medical Center.Maastricht.The Netherlands Geisinger Wyoming Valley Medical Center.Wilkes-Barre PA.United States of America1National Heart and Lunginstitute Imperal College London.United Kingdom:andArmhythmia and Electrophysiology UnitSanta Maria della Misericordia General Hospital Rovgo.ItalyRecelved 3 February 2023:accepted after evislon 3 February 2023AbstractConduction system pacing(CSP)has emerged as a more physiological alternative to right ventricular pacing and is also beingused in selected cases for cardiac resynchronization therapy.His bundle pacing was first introduced over two decades agoand its use has risen over the last years with the advent of tools which have facilitated implantation.Left bundle branch areapacing 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.Thisdocument aims to standardize the procedure and to providea framework for physicians who wishto start CSP implantation,or who wish to improvetheir technique.A synopsis is provided in this print edition of EPEuropace.The full document maybe consulted online,and a 'Key Messages'App can be downloaded from the EHRA website.KeywordsConduction system pacing.His bundle pacing.Left bundle branch area pacing.Device implantationAbbreviationsDSPdeep septal pacingECGelectrocardiogramAatrialEGMelectrogramAVNatrioventricular nodeHBPHis bundle pacingCOIcurrent of injuryisoisoelectricCScoronary sinusLAOleft anterior obli
