Conventional biventricular pacing is still preferred to conduction system pacing for atrioventricular block in patients with reduced ejection fraction and narrow QRS.

It is well established that right ventricular pacing is detrimental in patients with reduced cardiac function who require ventricular pacing (VP), and alternatives nowadays are comprised of biventricular pacing (BiVP) and conduction system pacing (CSP). The latter modality is of particular interest in patients with a narrow baseline QRS as it completely avoids, or minimizes, ventricular desynchronization associated with VP. In this article, experts debate whether BiVP or CSP should be used to treat these patients.
Competing Interests: Conflict of interest: H.B. has received institutional research and fellowship support and/or speaker fees from Abbott, Biotronik, Boston Scientific, Medtronic, Microport. M.G. is on an advisory board of Medtronic and received speaker fees from Abbott. M.R.G. has received institutional research support from Abbott and Boston Scientific, Medtronic and consulting fees from Boston Scientific and Medtronic. M.J. has received speaker/consultant fees from Medtronic, Abbott and Biotronik. K.E. has not reported any disclosures.
(© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)