In patients with prolonged atrioventricular conduction and PM indication due to sinus node dysfunction or intermittent AV block, who do not require continuous ventricular pacing, it may be challenging to determine the most appropriate pacing strategy. The current standard of care is to program the pacemaker with specific algorithms designed to minimize unnecessary ventricular pacing. However, the superiority of this approach over standard DDD/R in improving clinical outcomes remains controversial. Conduction system pacing may offer a more physiological alternative, ensuring appropriate AV conduction and preventing pacing-induced dyssynchrony.