Recently, permanent His bundle pacing (HBP) has emerged as a viable pacing strategy for chronic ventricular pacing. It allows for recruitment of the native His Purkinje system thereby preventing pacing-induced ventricular dyssynchrony seen in traditional right ventricular pacing. Current tools allow for relatively good success rates for implantation. Understanding the various responses to HBP is crucial for long-term success. With better tools and unique pacing and sensing algorithms designed specifically for this form of pacing, HBP is likely to increase as a tool for long-term pacing therapy.