Conduction system pacing (CSP) restores physiological ventricular activation by directly stimulating the His-Purkinje network. His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) represent complementary techniques that achieve conduction system capture and maintain ventricular synchrony in patients with narrow or wide QRS. The development of LBBAP has broadened the applicability of CSP while preserving its physiological rationale. In contrast to right ventricular pacing, which induces dyssynchrony and adverse remodeling, CSP maintains electromechanical coordination and improves long-term clinical outcomes.