Physiological Pacing for the Prevention and Treatment of Heart Failure: a State-of-the-Art Review

•Cardiac physiological pacing, defined as any form of cardiac pacing intended to restore or preserve the synchrony of ventricular contraction, has evolved over the past 25 years.•This article reviews how cardiac physiological pacing has expanded the indications of permanent pacing to treat or prevent heart failure.•To optimize the hemodynamic benefits of cardiac physiological pacing, a multidisciplinary team-based approach to patient selection and individualized pacemaker programming is needed. Permanent pacing from the right ventricular apex can reduce quality of life and increase the risk of heart failure and death. This review summarizes the milestones in the evolution of pacemakers toward physiological pacing with biventricular pacing systems and lead implantation into the cardiac conduction system to synchronize cardiac contraction and relaxation. Both approaches aim to reproduce normal cardiac activation and help to prevent and treat heart failure. This review introduces the basic concepts and clinical evidence and discusses the practical uses of physiological pacing. [Display omitted]