Extremely Late Complete AV Block After TAVR: ECG Clues and Correction With Left Bundle Branch Pacing.
Ngoc Dung Kieu, Cao Dat Tran, Le Uyen Phuong Tran et al.
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Case in brief
A 63-year-old man developed complete atrioventricular block 17 months after transcatheter aortic valve replacement with an Evolut-R 29 mm valve. Serial ECGs had shown progressive conduction abnormalities, from left anterior fascicular block to complete left bundle branch block with first-degree AV block. Electrophysiological testing showed AH and HV intervals of 75 ms and 78 ms, and prolonged ambulatory monitoring detected intermittent high-grade block. Left bundle branch pacing provided physiologic ventricular activation and corrected the conduction abnormalities; symptoms resolved and pacing parameters remained stable at follow-up.
What made this case unusual
The complete AV block occurred 17 months after TAVR, following progressive ECG changes that preceded the clinical presentation.
Diagnostic / clinical pearl
Progressive ECG abnormalities after TAVR may precede late high-grade AV block; this case supports prolonged rhythm surveillance when such changes are present.
Why it matters
Left bundle branch pacing both provided reliable pacing and corrected ventricular conduction abnormalities in this patient.