Pacing Pandemonium: The Unexpected Outcome of Temporary Pacing

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Electrophysiology

Background:

• Transcatheter aortic valve implantation (TAVI) is a minimally invasive procedure for aortic stenosis.
• Complications, though rare, can occur during TAVI, impacting cardiac function.
• Understanding potential procedural risks is crucial for patient safety.

Purpose of the Study:

• To report the first case of left bundle branch capture by a pacing catheter during TAVI.
• To highlight an unusual complication involving interventricular septum perforation.
• To discuss the implications for procedural monitoring and management.

Main Methods:

• Case report detailing a specific clinical event during TAVI.
• Utilized temporary pacing catheter and diagnostic imaging.
• Described the anatomical pathway of catheter perforation and capture.

Main Results:

• Successful TAVI procedure was completed.
• Inadvertent perforation of the interventricular septum by a temporary pacing catheter occurred.
• Capture of the left bundle branch by the pacing catheter was confirmed.

Conclusions:

• Left bundle branch capture is a potential, albeit rare, complication of TAVI.
• Prompt recognition and management are essential if this complication arises.
• This case underscores the importance of vigilant monitoring during TAVI procedures.