Key result
Post-TAVR intermittent LBBB with marked PR prolongation may mask high-risk trifascicular disease requiring PPM.
Case Report (n=1)
Intermittent left bundle branch block after TAVR, especially with marked PR prolongation preceding apparent QRS narrowing, warrants careful evaluation for high-risk trifascicular disease.
May warrant closer post-TAVR conduction surveillance; leaves open whether intermittent LBBB independently drives outcomes or merits intervention.
CASE SUMMARY: An 87-year-old man with pre-existing first-degree atrioventricular block underwent transfemoral transcatheter aortic valve replacement (TAVR) for severe aortic stenosis. Postprocedure, he developed worsening first-degree atrioventricular block and intermittent left bundle branch block with a paradoxical electrocardiographic pattern: Slightly longer PR intervals were associated with narrow QRS beats, whereas shorter PR intervals resulted in marked QRS widening. Electrophysiology study revealed advanced infra-Hisian conduction disease, with greater prolongation of the His-ventricular interval before narrow QRS beats, prompting permanent pacemaker implantation. TAKE-HOME MESSAGE: This case demonstrates that intermittent left bundle branch block after TAVR-particularly when associated with marked PR prolongation preceding apparent QRS narrowing-warrants careful evaluation, as it may mask high-risk trifascicular disease.
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Cardinali et al. (2026) conducted a case report in Severe aortic stenosis, post-TAVR conduction disease (n=1). Transcatheter aortic valve replacement (TAVR) was evaluated on Intermittent left bundle branch block and advanced infra-Hisian conduction disease. Intermittent left bundle branch block after TAVR with marked PR prolongation preceding apparent QRS narrowing may mask high-risk trifascicular disease requiring permanent pacemaker implantation.
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