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Aims: Permanent transseptal left bundle branch area pacing (LBBAP) is a promising new pacing method for both bradyarrhythmia and heart failure indications. However, data regarding safety, feasibility and capture type are limited to relatively small, usually single centre studies. In this large multicentre international collaboration, outcomes of LBBAP were evaluated., Methods and Results: This is a registry-based observational study that included patients in whom LBBAP device implantation was attempted at 14 European centres, for any indication. The study comprised 2533 patients (mean age 73.9 years, female 57.6%, heart failure 27.5%). LBBAP lead implantation success rate for bradyarrhythmia and heart failure indications was 92.4% and 82.2%, respectively. The learning curve was steepest for the initial 110 cases and plateaued after 250 cases. Independent predictors of LBBAP lead implantation failure were heart failure, broad baseline QRS and left ventricular end-diastolic diameter. The predominant LBBAP capture type was left bundle fascicular capture (69.5%), followed by left ventricular septal capture (21.5%) and proximal left bundle branch capture (9%). Capture threshold (0.77 V) and sensing (10.6 mV) were stable during mean follow-up of 6.4 months. The complication rate was 11.7%. Complications specific to the ventricular transseptal route of the pacing lead occurred in 209 patients (8.3%)., Conclusions: LBBAP is feasible as a primary pacing technique for both bradyarrhythmia and heart failure indications. Success rate in heart failure patients and safety need to be improved. For wider use of LBBAP, randomized trials are necessary to assess clinical outcomes., Competing Interests: Conflict of interest: G.K., N.R., A.E, P.S.. L.H, M.C. and D.G—nothing to declare; M.J., P.M., W.H. and S.T. report speaker and consultancy fees from Medtronic; K.V. reports consultancy for Biosense Webster, Philips, Medtronic, Abbott, reports speaker fees from Microport and K.V.'s institution has received research and educational grants from Philips, Abbott, Medtronic, Biosense Webster; O.C. reports consulting fees from Biotronik, Medtronic and Boston Scientific and speaker’s fees from Medtronic and Boston Scientific; F.Z. reported speaker fees from Abbott, Biotronik, Boston Scientific, Medtronic and Microport; A.E.’s institution received speaker and advisory fees from Boston Scientific and Medtronic; H.B. reports speaker and/or consultancy fees (minor) from Abbott, Biotronik, Boston Scientific, Medtronic and Microport; Z.W. reports advisor and speaker fees from Medtronic, Boston Scientific advisor and Abbott Advisory board member; J. De P. reports speaker fees and honoraria from Medtronic, Boston Scientific and Biotronik. K.C. reports speaker and consultant fees for Medtronic and Biotronik., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.)