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Intermittent Left Bundle Branch Block After Transcatheter Aortic Valve Replacement: Electrophysiological and Clinical
Francesco Cardinali1, Michela Casella2, Marco Di Eusanio3
1Cardiology and Arrhythmology Clinic, University Hospital "Azienda Ospedaliero-Universitaria delle Marche," Ancona, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy.
JACC. Case Reports
|May 21, 2026
Summary
Transcatheter aortic valve replacement (TAVR) can unmask high-risk trifascicular disease, presenting as intermittent left bundle branch block. Careful evaluation is crucial, especially with paradoxical electrocardiographic patterns, to identify advanced conduction abnormalities.
Area of Science:
- Cardiology
- Electrophysiology
- Interventional Cardiology
Background:
- Severe aortic stenosis necessitates intervention, with transcatheter aortic valve replacement (TAVR) being a common treatment.
- Pre-existing conduction abnormalities, such as atrioventricular block, can be present in patients undergoing TAVR.
- Left bundle branch block (LBBB) is a known potential complication post-TAVR.
Purpose of the Study:
- To describe a unique electrocardiographic pattern observed after TAVR.
- To highlight the potential for TAVR to unmask underlying high-risk conduction disease.
- To emphasize the importance of thorough electrophysiological evaluation in specific post-TAVR scenarios.
Main Methods:
- Case report of an 87-year-old male with severe aortic stenosis undergoing TAVR.
- Detailed analysis of post-TAVR electrocardiographic findings, including paradoxical PR interval and QRS duration relationship.
- Electrophysiology study to assess infra-Hisian conduction.
Main Results:
- The patient developed worsening atrioventricular block and intermittent left bundle branch block post-TAVR.
- A paradoxical electrocardiographic pattern was noted: longer PR intervals with narrow QRS, and shorter PR intervals with wide QRS.
- Electrophysiology study confirmed advanced infra-Hisian conduction disease, necessitating pacemaker implantation.
Conclusions:
- Intermittent left bundle branch block after TAVR, especially with paradoxical ECG findings, may indicate high-risk trifascicular disease.
- Such patterns warrant careful electrophysiological evaluation to avoid misdiagnosis.
- Prompt pacemaker implantation may be required for advanced conduction abnormalities identified post-TAVR.
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