LBBAP Technique — EECC MCQ
Instant feedback + full explanation. One question, done properly.
Educational content. Not a substitute for clinical judgement or local policy.
Reveal the answer and explanation
Correct answer: E — LBBAP involves advancing a pacing lead through the interventricular septum to capture the left bundle branch or its fascicles, producing rapid physiological LV activation — emerging evidence suggests comparable CRT effect to conventional BiV pacing with simpler implantation and more stable thresholds
Left bundle branch area pacing (LBBAP) is the newest conduction system pacing (CSP) technique: a standard pacing lead is advanced through the interventricular septum (using a stylet-driven approach through a delivery sheath) until the distal tip captures the left bundle branch or its fibres. This produces near-physiological LV activation with a narrow paced QRS. Advantages over conventional BiV CRT: (1) single lead (vs BiV requiring CS lead + RV lead); (2) avoids CS anatomy limitations (no suitable veins, phrenic nerve stimulation); (3) more stable pacing thresholds than His bundle pacing; (4) may correct LBBB (if the block is proximal to the pacing site). The LOT-CRT trial showed non-inferior outcomes to BiV CRT. The 2021 ESC Pacing Guidelines include CSP (HBP and LBBAP) as emerging alternatives (Class IIb), with rapidly accumulating evidence.
Reference: ESC (2021): Pacing/CRT Guidelines; LOT-CRT Trial