Non-invasive assessment of coronary artery disease in patients with left bundle branch block

•Diagnosis of angina in patients with LBBB poses a diagnostic challenge.•Non-invasive techniques have both benefits and limitations.•Patients are often subjected to potentially unnecessary coronary angiography.•In this review we examine the use of current non-invasive imaging techniques.

There is a high prevalence of coronary artery disease (CAD) in patients with left bundle branch block (LBBB); however there are many other causes for this electrocardiographic abnormality. Non-invasive assessment of these patients remains difficult, and all commonly used modalities exhibit several drawbacks. This often leads to these patients undergoing invasive coronary angiography which may not have been necessary. In this review, we examine the uses and limitations of commonly performed non-invasive tests for diagnosis of CAD in patients with LBBB.