Left bundle branch area pacing (LBBAP) offers a physiological pacing approach capable of maintaining native ventricular activation in patients with narrow QRS complexes requiring permanent pacing. This case illustrates the technical steps, challenges, and solutions encountered during LBBAP implantation in an elderly patient with atrial flutter and bradycardia. Accurate sheath selection and unipolar electrogram monitoring enabled successful septal penetration and identification of the left bundle potential, confirmed by current of injury (COI) evolution. Long-term follow-up demonstrated stable electrical parameters and persistent conduction system capture.