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AIMS In this study, we investigated the characteristics and underlying mechanisms of the electrocardiographic (ECG) morphology during left bundle branch area pacing (LBBAP), which have not been systematically described. METHODS Patients with indications for permanent cardiac pacing underwent LBBAP attempts. The ECGs of patients with confirmed left bundle branch (LB capture were compared with those of individuals with right bundle branch block (RBB on 12-lead ECG. Intracardiac electrograms recorded during implantation were analyzed in all patie