Iatrogenic VSDs After TAVRs and Electrophysiologic Implications

Iatrogenic ventricular septal defects (VSDs) are rare but important complications of transcatheter aortic valve replacement (TAVR). In patients who develop conduction abnormalities post-TAVR, the presence of a VSD can complicate pacing strategies. We report 2 cases of perimembranous VSDs after TAVR, both complicated by conduction disease and managed with left bundle branch pacing (LBBP). The first patient underwent a redo valve procedure that was complicated by a Gerbode-type defect and pulmonary hypertension, culminating in a palliative approach. The second patient developed a restrictive VSD diagnosed on follow-up, with symptom improvement on medical therapy. In both cases, successful LBBP was achieved using septal drilling and precise lead placement despite septal disruption. Post-TAVR VSDs are uncommon and poorly characterized. These cases underscore the feasibility of LBBP in this complex setting and the need for individualized procedural planning. Post-TAVR VSDs warrant high clinical suspicion. LBBP is a viable pacing strategy when tailored to altered septal anatomy.