Sudden Death After Transcatheter Aortic Valve Implantation. Are Bradyarrhythmias Always The Cause?

Transcatheter Aortic-Valve Implantation (TAVI) is considered to be highly effective in the treatment of high-risk patients with severe aortic stenosis. After TAVI, the rate of pacemaker implantation is 6.5%-40%. Some reports of sudden death after TAVI are mostly attributed to bradyarrhythmias. We report the case of three patients who experienced sudden cardiac death or aborted sudden cardiac death after TAVI. All patients were affected from ischemic heart disease with an ejection fraction of approximately 40% and underwent pacemaker implantation (PM) after the procedure due to 1rst degree atrioventricular block (AV) and left bundle branch block (LBBB). One of the patients died suddenly 30 days after the procedure. The PM interrogation revealed many episodes of non sustain ventricular tachycardias (NSVT) and one episode of ventricular fibrillation (VF) that led to death. The other two patients had syncope and during PM interrogation episodes of ventricular tachycardia >12 sec were recorded. Patients affected by ischemic heart disease undergoing TAVI, especially with borderline coronary lesions should receive particular attention in order to avoid potentially lethal ventricular arrhythmias. In addition, the physiopathologic mechanism of sudden arrhythmic death in these patients needs to be clarified.