His Bundle Pacing represents a major advancement in physiologic pacing, delivering electrical impulses directly into the native conduction system to preserve natural ventricular activation. This session provides an in-depth exploration of indications, techniques, device programming, and follow-up, designed for clinicians who want a structured His Bundle Pacing pathway similar to what they would experience at a focused cardiology conference, where practical tips, evidence, and advanced His bundle pacing strategies are discussed in detail.

The description begins with a concise review of conduction system anatomy, focusing on the His-Purkinje network and its role in coordinated ventricular depolarization. Participants will understand how conventional right-ventricular apical pacing can create electrical dyssynchrony, widen QRS complexes, and promote pacing-induced cardiomyopathy in susceptible patients. In contrast, His bundle pacing preserves or restores near-normal activation, improving mechanical synchrony and long-term ventricular performance.

A central part of the session addresses implantation technique. Attendees will learn how to map the His signal, distinguish selective from non-selective capture, and position the lead using dedicated sheaths and fluoroscopic landmarks. Practical guidance covers lead fixation, threshold testing, output safety margins, and common pitfalls such as far-field sensing, high capture thresholds, or poor stability in scarred septal regions.

The session then explores clinical indications, including AV block, sinus node dysfunction, atrial fibrillation with slow ventricular response, pacing after TAVR, and heart failure patients who would otherwise receive high-burden right-ventricular pacing. Participants will see how conduction system pacing can be used alone or in combination with CRT concepts, and how to decide when left bundle branch pacing may be preferable.

Troubleshooting and follow-up are addressed through case-based examples that demonstrate threshold rise, loss of capture, and lead dislodgement. Attendees will learn how to reprogram sensing vectors, adjust outputs, and decide when a lead revision is necessary. Strategies for remote monitoring, integration with device clinics, and communication with referring physicians are also discussed.

Future directions include new lead designs tailored to conduction tissue, electroanatomic and ultrasound-guided implantation, automatic capture management, and integration of conduction system pacing algorithms into standard device platforms. By the end of the session, participants will be able to explain the rationale for physiologic pacing to patients and colleagues, compare His bundle pacing with traditional and biventricular approaches, and design local protocols for case selection, implantation, and follow-up. Clear algorithms, example reports, and shared decision-making frameworks ensure that the knowledge gained can be immediately applied, strengthening pacing practice in a broad range of clinical settings.