Henry Ford Health System Henry Ford Health System Henry Ford Health System Scholarly Commons Henry Ford Health System Scholarly Commons Cardiology Articles Cardiology/Cardiovascular Research 9-17-2020 Late onset complete heart block after transcatheter aortic valve Late onset complete heart block after transcatheter aortic valve replacement treated with permanent His-bundle pacing replacement treated with permanent His-bundle pacing Sati Patel Khaled Jamoor Arfaat Khan Waddah Maskoun Follow this and additional works at: https://scholarlycommons.henryford.com/cardiology_articles
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Henry Ford Health System Henry Ford Health System
Henry Ford Health System Scholarly Commons Henry Ford Health System Scholarly Commons
Cardiology Articles Cardiology/Cardiovascular Research
9-17-2020
Late onset complete heart block after transcatheter aortic valve Late onset complete heart block after transcatheter aortic valve
replacement treated with permanent His-bundle pacing replacement treated with permanent His-bundle pacing
Sati Patel
Khaled Jamoor
Arfaat Khan
Waddah Maskoun
Follow this and additional works at: https://scholarlycommons.henryford.com/cardiology_articles
in TAVR patients who have undergone PMI. However, a recent meta-
analysis found an overall harmful effect of PMI on all cause death and
heart failure hospitalizations.13 As HBP has been found to improve
quality of life, improve ejection fraction, and reduce heart failure hos-
pitalizations in the general population, it represents an attractive alter-
native for TAVR patients.12 Sharma et al studied 30 patients with pros-
thetic valves undergoingHBP: 12 patients had prosthetic aortic valves,
PATEL ET AL. 3
F IGURE 2 Late development of complete heart block with junctional escape rhythm. A, (Top) ECG from outside cardiologist office; note thepresence of inverted P-waves is suggestive of sinus node dysfunction. B, (Bottom) ECG at electrophysiology clinic visit [Color figure can be viewedat wileyonlinelibrary.com]
four of which were via TAVR.17 The study found prosthetic aortic
valves (including TAVR) useful as fluoroscopic landmarks with the HB
located inferiorly relative to the valve.Hence, presenceof a TAVRvalve
may improve feasibility of HBP as it serves as a radiographic guide.
Future studies should be dedicated to evaluating outcomes of HBP
post-TAVR.
4 CONCLUSION
Very late development of complete heart block post-TAVR with-
out preexisting CD poses a significant concern as a cause of
late major adverse events related to TAVR. HBP might be a
feasible option in a portion of this patient population, and the
valve, itself a fluoroscopic marker, can serve as an asset for His
localization.
AUTHOR CONTRIBUTIONS
Study concept and design: Khaled Jamoor and Waddah Mask-
oun. Drafting of the manuscript: Sati Patel. Critical revision of the
manuscript for important intellectual content: Waddah Maskoun.
Approval of the article: Arfaat Khan.
ORCID
Sati PatelMD https://orcid.org/0000-0002-7039-029X
F IGURE 3 A-C, Clockwise: TAVR valve with respect to pacing leads during placement (A) and the following day (B). ECG post-His-bundlepacing (C) [Color figure can be viewed at wileyonlinelibrary.com]
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