Syncope After Transcatheter Aortic Valve Replacement: Two Faces of Abnormal Intraventricular Conduction

Abstract

Conduction system damage is the most common complication of transcatheter aortic valve replacement (TAVR), which frequently requires placement of a permanent pacemaker. Bundle branch reentry (BBR) is a well-recognized mechanism of ventricular tachycardia (VT) in the setting of abnormal intraventricular conduction. We describe a case of a patient with post-TAVR intraventricular conduction abnormalities who presented with intermittent advanced atrioventricular block and BBR VT and discuss the potential risks, diagnosis, and management of BBR after TAVR.

A Case of Bundle Branch Re-entrant Ventricular Tachycardia 1 Year After Transcatheter Aortic Valve Replacement

“…Rare case reports of BBR-VT following surgical aortic valve replacement and TAVR have been published. 12 , 14 – 17 Our literature search showed 4 case reports of BBR-VT following TAVR and all of them occurred in the first 2 weeks post-TAVR. A prolonged H–V interval was reported in 3 cases and 1 case did not report the H–V interval.…”

Left Bundle-Branch Block Tachycardia After Transcatheter Aortic Valve Replacement

“…1 To our best knowledge, only 2 case reports of LBBB-VT attributable to BBR after TAVR have been published to date. 2,3…”

“…A 74-year-old man was referred for transcatheter aortic valve replacement (TAVR) attributable to severe symptomatic aortic stenosis (valve area, 0.8 cm 2 ; peak and medium transaortic pressure gradients, 60 and 40 mm Hg, respectively). He had a medical history of coronary artery disease with a stent placed at the mid-left anterior descending artery 4 years earlier; however, he denied any previous hospitalization for acute myocardial infarction.…”

“…1 To our best knowledge, only 2 case reports of LBBB-VT attributable to BBR after TAVR have been published to date. 2,3 The incidence of BBR-VT after TAVR is unknown. Our case should stimulate consideration of this diagnosis and of performance of programmed ventricular stimulation in post-TAVR patients exhibiting VT of either LBBB or RBBB morphology, as well as in those with syncope or aborted cardiac arrest.…”