Key result
Post-TAVR PR and RP prolongation heralds complete AV block and arrest in preexisting RBBB.
Why the study?
TAVR can cause high-degree AV block requiring pacemaker implantation, and preexisting C-RBBB is a known risk factor for advanced AV block after TAVR.
Case Report (n=1)
Inverse decremental conduction (PR prolongation with RP lengthening) may serve as an early warning sign for impending complete AV block and sudden cardiac arrest in patients with preexisting C-RBBB undergoing TAVR.
Transcatheter aortic valve replacement (TAVR) is a minimally invasive therapy for patients with symptomatic severe aortic stenosis and has become popular in the past decade. However, TAVR can result in high-degree atrioventricular (AV) block requiring pacemaker implantation.1,2 Preexisting complete right bundle branch block (C-RBBB) is an independent risk factor for development of advanced AV block following TAVR.3 I present a case in which prolongation of the PR interval with lengthening of the RP interval, which likely reflects inverse decremental conduction in left bundle branch (LBB) in a patient with preexisting C-RBBB, heralds sudden cardiac arrest owing to complete AV block and asystole.
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Gan‐Xin Yan (2021) conducted a case report in Severe aortic stenosis with preexisting complete right bundle branch block (n=1). Transcatheter aortic valve replacement (TAVR) was evaluated on Complete AV block and asystole. In a patient with preexisting complete right bundle branch block, prolongation of the PR interval with lengthening of the RP interval following TAVR heralded sudden cardiac arrest due to complete AV block.
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