Cardiac resynchronization therapy (CRT) is one of the most exciting recent advancements and has been revolutionary in the treatment of patients with congestive heart failure (CHF). CRT is a well-accepted therapy for the treatment of symptomatic systolic heart failure in defined patient subgroups. In addition chronic right ventricular pacing leads to a nonphysiological and dyssynchronous electrical and mechanical pattern of activation of the ventricles and may predispose some patients to pacing-induced heart failure and cardiomyopathy. Permanent His bundle pacing is an emerging technique to deliver a more physiological pattern of ventricular pacing and has the potential to mitigate the adverse consequences of chronic right ventricular pacing and promote atrioventricular and intraventricular synchrony. In this book chapter we present a comprehensive review of CRT and His bundle pacing in the light of all available evidence.