Implantation technique of His bundle pacing.

His bundle pacing (HBP) preserves physiological ventricular synchrony, with clinical benefits particularly evident when a high percentage of ventricular pacing is required. First experiences with standard leads and manually shaped stylets produced the impression that HBP is highly complex and time-consuming. However, with dedicated leads and sheaths, reliable HBP can be achieved in routine clinical practice. Implantation success in more than 90% of patients can be reached with current technology and has been shown to be reliable and effective, both at implantation and during long-term follow-up. At the same time, fluoroscopy and total procedural time can be reduced. New customized technologies will continue to improve the implant success rate and system performance. Large randomized trials will prove the long-term clinical benefits of HBP definitively and may render HBP the first choice in patients requiring ventricular pacing.