1) How does LBBAP perform in AV block with expected high ventricular pacing?
By preserving synchrony, LBBAP is suited for patients needing near‑continuous pacing, potentially reducing pacing‑induced cardiomyopathy compared with RV apical pacing.
2) Is LBBAP useful in patients with baseline LBBB?
In select cases, capturing the left conduction system may narrow QRS and improve mechanics; patient selection and mapping are key.
3) What about permanent AF with AV node ablation?
After AV node ablation, LBBAP can provide near‑physiologic ventricular activation for rate control strategies requiring 100% pacing.
4) How does LBBAP compare with His‑bundle pacing (HBP)?
LBBAP often offers lower chronic thresholds and broader capture in distal conduction disease than HBP, with similar physiologic intent; HBP may be preferred for proximal block if thresholds are stable.
5) How should LBBAP be weighed against leadless pacing options?
Leadless systems avoid transvalvular leads and pocket complications, but single‑chamber options may lack AV synchrony; LBBAP can restore synchrony at the cost of a transvenous lead—shared decision‑making is essential.