Transient left anterior and septal fascicular blocks after self‐expandable percutaneous transcatheter aortic valve implantation

Abstract

Transcatheter aortic valve implantation (TAVI) is indicated in severe symptomatic aortic stenosis, when there is intermediate-high surgical risk, or a condition considered inoperable, as in the case of "porcelain aorta" that could turn clamping or cannulation of the ascending aorta hazardous in open-heart surgery. Among the complications of this less invasive procedure, intraventricular conduction disorders subsequent to the procedure stand out. TAVI causes worsening of intraventricular dromotropic disorders in more than 75% of the cases, with the presence of preexisting right bundle branch block and first-degree atrioventricular block, deep prosthesis implant, male gender, size of the aortic annulus smaller than the prosthesis, and porcelain aorta being predictive of requirement for permanent pacemaker implant.

The tetrafascicular nature of the intraventricular conduction system

“…Hence, the patient had a left bifascicular block consisting of LAFB + LSFB. [1][2][3][4][5] We have presented several cases indicating that LSFB is not necessarily a rare ECG finding. Although well known from textbooks and other sources, isolated left posterior fascicular block (LPFB) without right bundle branch block (RBBB) is a very rare finding.…”

“…LSFB has been described in the following scenarios [1][2][3][4][5] : proximal obstruction of the left anterior descending (LAD) coronary artery with or without acute coronary syndrome and with the Wellens syndrome 6 ; exercise-induced during the treadmill test, 7 chronic Chagasic myocarditis 8 ; Kearns-Sayre syndrome 9 ; self-expandable percutaneous transcatheter aortic valve implantation 1 ; diabetes 10 ; and aberrant conduction in healthy individuals. 11 As data on LSFB is missing, so far there is no epidemiological data to establish the exact prevalence of all four main blocks of the left His system.…”