Iatrogenic VSDs After TAVRs and Electrophysiologic Implications.

BACKGROUND

Iatrogenic ventricular septal defects (VSDs) are rare but important complications of transcatheter aortic valve replacement (TAVR). In patients who develop conduction abnormalities post-TAVR, the presence of a VSD can complicate pacing strategies.

CASE SUMMARY

We report 2 cases of perimembranous VSDs after TAVR, both complicated by conduction disease and managed with left bundle branch pacing (LBBP). The first patient underwent a redo valve procedure that was complicated by a Gerbode-type defect and pulmonary hypertension, culminating in a palliative approach. The second patient developed a restrictive VSD diagnosed on follow-up, with symptom improvement on medical therapy. In both cases, successful LBBP was achieved using septal drilling and precise lead placement despite septal disruption.

DISCUSSION

Post-TAVR VSDs are uncommon and poorly characterized. These cases underscore the feasibility of LBBP in this complex setting and the need for individualized procedural planning.

TAKE-HOME MESSAGES: Post-TAVR VSDs warrant high clinical suspicion. LBBP is a viable pacing strategy when tailored to altered septal anatomy.