Congenitally Corrected Transposition of the Great Arteries (CCTGA) is a rare congenital heart disease characterized by atrioventricular and ventriculoarterial discordance, commonly accompanied by atrioventricular block (AVB), tricuspid valve abnormalities, and ventricular septal defects, etc. In pediatric patients with CCTGA, AVB requiring pacing therapy often occurs due to surgical damage, with epicardial pacing being commonly used. For older children or adult patients, conventional right ventricular pacing (CRVP) is now commonly used, which, while stable and safe, can induce ventricular dyssynchrony, exacerbating symptoms of heart failure and tricuspid valve dysfunction. Cardiac physiological pacing (CPP) includes Cardiac Resynchronization Therapy (CRT) and Conduction System Pacing (CSP), which encompasses His Bundle Pacing (HBP) and Left Bundle Branch Area Pacing (LBBAP). CRT with biventricular pacing maintains ventricular synchrony but anatomical variations in the coronary sinus (CS) in CCTGA add complexity to lead placement. The unique anatomical structure of the conduction system in CCTGA provides potential pacing conditions for HBP, LBBAP, and even Right Bundle Branch Pacing (RBBP). This review provides an overview of pacing treatment options for CCTGA combined with AVB, based on the anatomy and pathophysiology of the CCTGA conduction system. It emphasizes areas requiring further research and explores physiological pacing strategies for CCTGA.