The main reasons for traditional right ventricle apical pacing were first, the ease of implantation and second, the stability of passive-fixation leads in the apical trabeculae. However, apart from some specific diseases like hypertrophic cardiomyopathy, apical pacing often results in substantial functional, hemodynamic, electrical, and structural changes as previously demonstrated in many studies. Only in recent years, interest in the use of alternate pacing sites has developed. Right ventricular outflow tract is the preferred site of pacing because of its potential advantages such as ease of application, better hemodynamics, synchronous activation, less myocardial perfusion defects than apical pacing. The present review article comprehensively discusses this novel technique in terms of its beneficial effects compared to apical pacing and as an alternative method for biventricular pacing.