Late ventricular standstill following an elective TAVI

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Electrophysiology

Background:

• Transcatheter aortic valve implantation (TAVI) is a common procedure for aortic stenosis.
• Permanent pacemaker implantation is a known complication of TAVI, often due to conduction system compromise.
• Predictive factors for post-TAVI conduction disease include baseline ECG abnormalities and specific TAVI device types.

Observation:

• This case report details a patient who developed significant conduction disease requiring emergency pacemaker implantation after TAVI.
• The patient presented with low-risk clinical features, a normal baseline ECG, and received a low-risk TAVI valve.
• Conduction abnormalities were unexpectedly delayed, manifesting over 72 hours post-procedure despite initial normal ECGs and telemetry.

Findings:

• Delayed onset of severe conduction disease post-TAVI can occur even in seemingly low-risk individuals.
• Standard pre-procedural risk stratification and immediate post-procedural monitoring may not identify all patients at risk for delayed complications.
• This case underscores the potential for late-emerging conduction issues following TAVI.

Implications:

• Extended rhythm monitoring may be warranted for select TAVI patients, even those without apparent pre-procedural risk factors.
• Further research is needed to identify novel predictors of delayed conduction disease after TAVI.
• This case highlights the importance of recognizing atypical presentations of post-TAVI complications.