A Case of Post-TAVI: Left Septal Fascicular Block & Right Bundle Branch Block

Area of Science:

• Cardiology
• Electrophysiology
• Cardiac Surgery

Background:

• Transcatheter aortic valve replacement (TAVI) is a common procedure for aortic stenosis.
• New-onset conduction abnormalities, including Right Bundle Branch Block (RBBB), can occur post-TAVI.
• Left Septal Fascicular Block (LSFB) is a less common finding, and its combination with RBBB post-TAVI is unprecedented.

Observation:

• This report details a unique case of a patient developing both LSFB and RBBB following TAVI.
• This specific combination of conduction blocks has not been previously documented in medical literature.
• The patient's electrocardiogram (ECG) revealed the presence of both LSFB and RBBB post-procedure.

Findings:

• The co-occurrence of LSFB and RBBB post-TAVI is rare and potentially indicates diffuse conduction system damage.
• RBBB following TAVI is known to be associated with an increased risk of complete atrioventricular block and pacemaker implantation.
• LSFB may serve as an electrocardiographic marker for systemic conduction abnormalities after TAVI.

Implications:

• Clinicians should actively screen for this combined conduction block pattern in patients post-TAVI.
• The presence of new LSFB and RBBB warrants a low threshold for considering permanent pacemaker implantation.
• Early detection and intervention are crucial to mitigate risks of complete heart block and sudden cardiac death in these patients.