Cardiac physiologic pacing aims to restore or approximate the cardiac native conduction and activation pattern. Among these strategies, conduction system pacing (CSP), represented by His bundle pacing and left bundle branch pacing (LBBP), has developed rapidly in recent years. In 2025, several randomized controlled trials and real-world studies further strengthened the evidence base for CSP. In patients with bradycardia, CSP has shown potential advantages over right ventricular pacing in preserving left ventricular function and reducing the incidence of pacing-induced cardiomyopathy. In patients with heart failure and those indicated for cardiac resynchronization therapy, comparative data between CSP and biventricular pacing continue to accumulate, and the potential value of combined strategies such as LBBP-optimized CRT is being further explored. Meanwhile, technological and device innovations are advancing in areas such as lead reliability, the use of defibrillation leads for LBBP, leadless CSP systems, and physiological atrial pacing. Overall, CSP is progressively driving pacing therapy toward a more physiological and precision-oriented approach. However, its long-term outcomes and optimal indications still require further confirmation through high-quality studies.