Key result
Right bundle branch ablation successfully terminates post-TAVR bundle branch reentrant VT with sustained arrhythmia-free survival.
Why the study?
Patients after TAVR can develop bundle branch reentrant ventricular tachycardia due to His-Purkinje conduction delay, and obtaining a discernible His bundle electrogram for diagnosis may be extremely challenging in these patients.
Case Report (n=1)
No
KEY TEACHING POINTS•Patients after transcatheter aortic valve replacement (TAVR) can present with presyncope/syncope related to ventricular tachycardia besides AV block. TAVR creates the right milieu of His-Purkinje conduction delay, which can allow bundle branch reentrant ventricular tachycardia (BBR-VT).•His bundle recordings during BBR-VT are an essential component for the appropriate diagnosis, but obtaining a discernible His bundle electrogram may be extremely challenging in patients post TAVR. Recording right bundle (RB) branch potential preceding each QRS, ventriculoatrial dissociation, and changes in RB-RB intervals during tachycardia wobble, along with entrainment maneuvers, is helpful in reaching the appropriate diagnosis.•Bundle branch block after aortic valve replacement may be attributable to incomplete transection of the left bundle fibers, as evident by development of RB branch block post ablation of RB in patients with BBR-VT. Open table in a new tab
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Lahiri et al. (2017) conducted a case report in Bundle branch reentrant ventricular tachycardia (BBR-VT) after transcatheter aortic valve replacement (TAVR) (n=1). Radiofrequency catheter ablation targeting the right bundle branch was evaluated on Arrhythmia-free survival and VT noninducibility. Radiofrequency catheter ablation of the right bundle branch successfully terminated post-TAVR bundle branch reentrant ventricular tachycardia, keeping the patient arrhythmia-free at 18 months.
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