New-onset atrioventricular nodal reentrant tachycardia after transaortic valve replacement: Is there a causal link?

Figure 1. A: The lead V1 of a 12-lead electrocardiogram showing progressive PR interval prolongation after transaortic valve replacement (TAVR) procedure without return to baseline. Left bundle branch block was noted immediately post-TAVR without improvement over time. B: A 6-lead KardiaMobile® ECG monitor (AliveCor, Mountainview, CA) strip during an episode of palpitation showing a wide complex tachycardia at 143 beats/minute.

Figure 2. A: A wide complex tachycardia (WCT) induced at a cycle length of 490 milliseconds (480–520 milliseconds fluctuation was noted) with 1:1 atrioventricular (AV) relationship and negative septal VA time of –30 milliseconds. Note the negative septal VA time due to delay in ventricular activation from left bundle branch block. B: Ventricular entrainment of the WCT revealed a V-A-V response with a long post-pacing interval minus tachycardia cycle length of approximately 290 milliseconds, ruling out atrial tachycardia, bundle branch reentrant ventricular tachycardia, and AV reentrant tachycardia, and thus confirming the diagnosis of typical atrioventricular nodal reentrant tachycardia.

Figure 3. A, B: Pre–transaortic valve replacement (TAVR) and post–slow pathway ablation 80-day follow-up 12-lead electrocardiograms. Note post-TAVR development of left bundle branch block and increase in PR interval from baseline 182 milliseconds to 212 milliseconds.