This study explored the use of two advanced pacing techniques, His Bundle Pacing (HBP) and Left Bundle Branch Area Pacing (LBBAP), for cardiac resynchronization therapy (CRT). The goal was to compare their pacing performance, safety, feasibility, and predictors of response using thematic analysis of semi structured interview conducted with electrophysiologists, cardiologists, nurses, and cardiac rhythm management technicians who have hands-on experience with these pacing methods. The findings revealed that both HBP and LBBAP improve the heart’s electrical activation more naturally than traditional biventricular pacing. However, LBBAP showed several advantages, including more consistent and narrower QRS complexes in ECG, lower pacing thresholds, and better sensing effectiveness. These features contribute to longer device life and fewer complications in future. LBBAP was also found to be easier to implant, with faster procedure times and more reproducible results after initial training. Its use was preferred especially in elderly or frail patients and those with complex heart anatomy. In contrast, HBP was often technically demanding and less predictable, requiring precise placement in the HIS bundle area and sometimes leading to re-interventions due to loss of heart rhythm capture. The study identified key factors that guide the decision to use one method over the other, such as the heart’s anatomy, the patient’s overall health, and the history of prior leads or devices. Narrowing of the QRS complex, a marker of synchronized ventricular contraction, stable pacing thresholds, and strong sensed signals were important predictors of successful therapy. Clinicians noted that LBBAP generally met these criteria across a wider range of patients. Recommendations were made to adopt LBBAP as the preferred approach in routine clinical practice while reserving HBP for select cases. Further research was encouraged to investigate long-term outcomes and complicated patient groups. Overall, this work provides valuable insights into the practical use of both conduction system pacing therap