Introduction. His Bundle pacing (HBP) is an emerging pacing technique that reproduces a more physiological ventricular synchronization than right ventricle pacing (RVP). However, its effects on the right ventricle (RV) performance are still unknown. Methods. In this observational study, we enrolled 84 patients (mean age 75.1±7.9 years, 64% male) with indication for pacemaker implantation to compare the effects of HBP versus RVP on RV performance. 42 patients (50%) underwent successful HBP and 42 patients (50%) apical RVP. Patients were evaluated both at baseline and after six months by transthoracic echocardiogram. Results. At six months follow up, we found a significant improvement in RV-GLS (baseline: HBP -17.2±4.7 vs. RVP -16.1±3.7 to 6-months: HBP -19.5±4.2 vs. RVP -13.6±2.9, p=<0.0001) and RV-FAC (baseline: HBP 33.8±3.9% vs. RVP 33.3±5.3% to 6-months: HBP 36.2±3.7% vs. RVP 30.9±5.1 %, p=<0.0001) with HBP whereas RVP was associated with a significant decline in both parameters. Moreover, RVP was associated with a significant worsening of TAPSE (baseline: HBP 20.2±4.1 mm vs. RVP 21.2±4.3 mm to 6-months: HBP 20.3±3.8 mm vs. RVP 18.5±3.5 mm, p=0.014) and tricuspid S wave velocity (baseline: HBP 11.2±2.9 cm/sec vs. RVP 11.8±2.3 cm/sec to 6-months: HBP 11.3±2.2 cm/sec vs. RVP 10.3±1.9 mm, p <0.0001) compared to HBP. Conversely from RVP, HBP significantly improved PASP (baseline: HBP 36.7±7.3 mmHg vs. RVP 34.6±6.1 mmHg to 6-months: HBP 32.4±5.9 mmHg vs. RVP 38.7±5.6 mmHg, p<0.0001) and tricuspid regurgitation (p=0.005) at six-months. Conclusions. HBP ensues a beneficial and protective impact on RV performance compared with RVP.