Abstract：The electrical synchronization after ventricular pacing is the target of physiological pacing. Longterm right ventricular apex pacing can increase the incidence rate of atrial fibrillation, heart failure and so on. Cardiac resynchronization therapy can improve the cardiac synchronization between the left and right ventricles. But there is still a 20 to 35 percent of nonresponse rate in clinical use, and the electrical synchronization after pacing differs from that of normal electrical conduction. His bundle pacing (HBP) is the real physiological pacing because of the pacing excitation point in His bundle and electrical excitation along HisPurkinje system. However, there are some difficulties in the clinical practice of HBP, such as low success rate in procedures, high pacing threshold, difficulties in electrode location and fixation, poor sensing of the ventricle, and so on. Left bundle branch pacing (LBBP) is a new pacing concept proposed in recent years, which aims to achieve a balance between electrical synchronization after pacing and the efficiency and safty of clinical operation. But there is not enough proof from largescale clinical studies supporting its indications and safty. This review interprets the theoretical basis, recent development, advantages, and problems of HBP and LBBP in the aspect of physiological electrical synchronization.
