His bundle pacing.

His bundle pacing (HBP) has recently emerged as a technique to avoid the negative effects of long-term right ventricular apical pacing. In addition to providing physiologic ventricular activation, HBP has been shown to correct underlying conduction abnormalities in certain patients. Although large prospective, randomized clinical trials have not yet been completed, the available observational clinical data support the safety and efficacy of this technique. Here, we review the physiology of the his bundle (HB) as it relates to HBP, describe the current clinical experience, and discuss future directions of this emerging therapy.