Proarrhythmia with left bundle branch area pacing for complete heart block after transcatheter aortic valve replacement

Figure 1. Telemetry tracing from the emergency department with complete heart block triggered by a premature ventricular complex with superior axis, consistent with paroxysmal atrioventricular block.

Figure 2. A: Twelve-lead electrocardiogram (ECG) at the time of presentation with left bundle branch block (LBBB). B: Twelve-lead ECG demonstrating nonselective left bundle pacing vs deep septal pacing (left ventricular activation time of 65 ms). C: Chest radiograph demonstrating high septal position of the left bundle pacing lead.

Figure 3. A: Intracardiac electrogram of the onset of the symptomatic ventricular tachycardia (VT). A premature ventricular complex at first triggers a brief episode of pleomorphic VT that organizes to monomorphic VT. B: Initiation of monomorphic VT triggered with a narrow premature ventricular complex (PVC), with right bundle branch block morphology and inferior axis suggestive of a high septal PVC, possibly near the Purkinje network. C: Arrhythmia log showing multiple episodes of nonsustained and sustained VT. D: Coronary angiography with right anterior oblique and cranial projection demonstrated absence of coronary thrombosis, and coronary artery injury related to the left bundle lead was not present.