Traditional right ventricular pacing prolongs the electrical and mechanical activation of the heart, which reduces the pump function, and in selected patients may lead to pacing-induced heart failure. Pacing the His bundle preserves the normal or near-normal activation pattern of the ventricles that prevents the detrimental effects of right ventricular pacing. This review discusses the techniques, feasibility, outcomes, and clinical impact of permanent His bundle pacing in patients with an indication for a cardiac implantable electronic device.