Contemporary goals of cardiac pacing have expanded beyond the primary need for reliable myocardial capture. Advances in implantation techniques have permitted novel pacing systems that aim to improve electrocardiographic measures, ventricular synchrony, left ventricular function, and objective clinical outcomes across a broader population of patients. Physiologic pacing strategies, including left bundle branch area pacing (LBBAP), have emerged as potentially beneficial therapies compared to conventional non-physiological pacing modalities, such as right ventricular (RV) pacing. The choice of cardiac pacing system requires thoughtful consideration and an understanding of the appropriate indications for these emerging cardiac pacing modalities.