Approximately 150,000 implantable cardioverter-defibrillators (ICDs) are implanted in the United States and 140,000 in Europe each year, representing a significant patient population for whom pacing performance has meaningful long-term consequences. Left bundle branch area pacing (LBBAP) has emerged as a conduction system pacing approach aiming to restore the heart’s natural pattern of electrical activation. Designated as an FDA breakthrough device, the UltiSynq lead is a program that expedites development and prioritizes review of medical devices with the potential to provide more effective treatment or diagnosis of life-threatening or irreversibly debilitating conditions.