His bundle pacing (HBP) can be performed safely and effectively using an electrogram-guided technique without fluoroscopy. By relying exclusively on intracardiac signals for His localization and lead fixation, this approach minimizes radiation exposure while maintaining procedural accuracy and success rates. The technique emphasizes that the His bundle is an electrical rather than an anatomical target, allowing precise positioning through real-time signal monitoring. Fluoroscopy is limited to sheath removal and confirmation of lead slack, achieving near-zero radiation exposure without additional costs or procedural time. This strategy represents a practical step toward fully fluoroscopy-free conduction system pacing and aligns with the ALARA principle.