Intra-procedural Transthoracic EChocardiogram to Facilitate Left Bundle Branch Area Pacing (LBBAP)

The goal of this observational study is to learn more about whether or not the use of heart ultrasound during pacemaker implantation is helpful. The main questions this aims to answer are:Does this help the doctors with figuring out the wire location during implantation?Does this reduce the wire placement procedure time?Does this reduce the x-ray imaging time during the procedure?Participants will be asked to:Have a physical exam and Echocardiogram (ECG) at initial visit, 2 weeks post implant, and 3 months post implant.Have a urine pregnancy test (if applicable)Have a heart ultrasound during implant procedureAnswer questions related to heart failure symptoms to see what stage of heart failure is presentHave device interrogation (a wand placed over the chest to see that the device is working properly) at a visit 2 weeks post implant and at 3 months post implant.

Inclusion Criteria:patient with indication for permanent pacemaker or Implantable Cardioverter Defibrillator (ICD) utilizing conduction system pacing lead for bradycardia or cardiac resynchronization therapypatient is willing to comply with all study procedures and be available for the duration of the studyExclusion Criteria:Inability to provide informed consentpregnantenrolled in a concurrent study that may confound the results of this study