His Bundle Pacing — EECC MCQ
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Correct answer: B — HBP captures the His bundle directly, producing physiological ventricular activation through the native conduction system — preserving ventricular synchrony and avoiding the pacing-induced dyssynchrony and cardiomyopathy risk associated with RV apical pacing
His bundle pacing (HBP) delivers pacing impulses directly to the His bundle, engaging the native His-Purkinje conduction system. This produces narrow QRS complexes (physiological activation pattern), maintaining biventricular synchrony. Advantages over RV apical pacing: (1) avoids pacing-induced dyssynchrony (LBBB-like activation pattern from RV pacing); (2) reduces risk of pacing-induced cardiomyopathy (10-20% with chronic RV pacing); (3) may correct pre-existing LBBB in some cases. The 2021 ESC Pacing Guidelines include HBP (and the newer LBBAP) as alternatives to conventional RV pacing (Class IIa) or as alternatives to CRT (Class IIb). Limitations of HBP: technically demanding implantation, higher pacing thresholds (faster battery depletion), and lead stability concerns. LBBAP has emerged as a more practical alternative with more stable thresholds.
Reference: ESC (2021): Pacing Guidelines