Key result
Dual-chamber right ventricular apical pacing abolished systolic anterior motion and reduced the peak LVOT gradient from 150 mm Hg to 24 mm Hg in a patient with late post-TAVR dynamic LVOT obstruction.
Why the study?
Successful management of left ventricular outflow tract obstruction developing late after transcatheter aortic valve replacement with right ventricular apical pacing had not been previously reported.
Case Report (n=1)
No
Absolute Event Rate: 24% vs 150%
May offer pacing option for rare late post-TAVR LVOT obstruction; hypothesis-generating and leaves open need for prospective validation.
We describe the first case of successful management of left ventricular outflow tract obstruction developing late after transcatheter aortic valve replacement with right ventricular apical pacing. The possible mechanisms of obstruction resolution are described. (Level of Difficulty: Advanced.)
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Weich et al. (2021) conducted a case report in Dynamic left ventricular outflow tract obstruction (LVOTO) post-transcatheter aortic valve replacement (TAVR) (n=1). Dual-chamber right ventricular apical pacing with echocardiographically optimized short atrioventricular delay vs. Pre-pacing baseline (after inadequate response to beta-blockade) was evaluated on Peak left ventricular outflow tract (LVOT) gradient (mm Hg). Dual-chamber right ventricular apical pacing abolished systolic anterior motion and reduced the peak LVOT gradient from 150 mm Hg to 24 mm Hg in a patient with late post-TAVR dynamic LVOT obstruction.
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