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According to guidelines, patients\u2019 selection for CRT is based on QRS duration (QRSd) and morphology by surface electrocardiogram (ECG). Cardiovascular imaging techniques evaluate cardiac structure and function as well as identify pathophysiological substrate changes including the presence of scar. Cardiovascular imaging helps by improving the selection of candidates, guiding left ventricular (LV) lead placement, and optimization devices during the follow\u2010up. Conduction system pacing (CSP) includes His bundle pacing (HBP) and left bundle branch pacing (LBBP) which is screwed into the interventricular septum. CSP maintains and restores ventricular synchrony in patients with native narrow QRSd and left bundle branch block (LBBB), respectively. LBBP is more feasible than HBP due to a wider target area. This review highlights the role of multimodality cardiovascular imaging including fluoroscopy, echocardiography, cardiac magnetic resonance (CMR), myocardial scintigraphy, and computed tomography (CT) in the pre\u2010procedure assessment for CSP, better selection for CSP candidates, the guidance of CSP lead implantation, and the optimization of devices programming after the procedure. We also compare the different characteristics of multimodality imaging and discuss their potential roles in future CSP implantation.<\/jats:p>","DOI":"10.1111\/pace.14644","type":"journal-article","created":{"date-parts":[[2022,12,14]],"date-time":"2022-12-14T18:29:24Z","timestamp":1671042564000},"page":"548-557","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cardiovascular imaging in conduction system pacing: What does the clinician need?"],"prefix":"10.1111","volume":"46","author":[{"given":"Yang","family":"Ye","sequence":"first","affiliation":[{"name":"Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, College of Medicine Zhejiang University  Hangzhou Zhejiang People's Republic of 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Hospital Zhejiang University School of Medicine  Hangzhou Zhejiang Province China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Captur","family":"Gabriella","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular Science University College London  London UK"},{"name":"Centre for Inherited Heart Muscle Conditions, Department of Cardiology Royal Free London NHS Foundation Trust  London UK"},{"name":"Medical Research Council Unit for Lifelong Health and Ageing at UCL  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guo\u2010sheng","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, College of Medicine Zhejiang University  Hangzhou Zhejiang People's Republic of 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