SUDDEN DEATH AFTER TAVI. ARE BRADYARRHYHTMIAS ALWAYS THE CAUSE?
L.P. Papavasileiou, K. Spargias, G. Zervopoulos, M. Chrisocheris, A. Chalapas, K. Bellos, L. Santini, G. Forleo, T. Apostolopoulos
Electrophysiology Pacemaker and ICD Unit, Hygeia Hospital, Athens, Greece. University Hospital of Rome "Tor Vergata", Cardiology Department, Rome, Italy. Transcutaneous Heart Valves Department, Hygeia Hospital, Athens, Greece. 1rst Cardiothoracic Surgery Department,Hygeia Hospital, Athens, Greece
Introduction:Transcatheter Aortic-Valve Implantation (TAVI) is consider to be highly effective in the treatment of patients with severe aortic stenosis who are inoperable. After TAVI, the rate of pacemaker implantation is from 6.5%-40%. Some reports of sudden death after TAVI are mostly attributed to bradyarrhythmias.
We report the case of three patients how experienced sudden cardiac death or aborted sudden cardiac death after TAVI.
All patient underwent TAVI for severe aortic stenosis and were affected from ischemic heart disease with an ejection fraction ? 40%. All patients underwent pacemaker implantation (PM) after the procedure due to 1rst degree atrioventricular block (AV) and left bundle branch block (LBBB). One of the patient’s died suddenly 30 days after the procedure. The PM interrogation reveled many episodes of non sustain ventricular tachycardias (NSVT) [fig 1] and ventricular fibrillation (VF) [fig 2]that lead to death. The other two patients had presyncope and during PM interrogation episodes of NSVT >15 sec were recorded [fig 3].
Conclusions: Particular attention should be addressed in patients affected by ischemic heart disease undergoing TAVI especially in the presence of borderline coronary lesions. The physiopathologic mechanism of sudden arrhythmic death in these patients needs to be clarified.
Figure 1. . Arrhythmic events recorded.
Figure 2. Ventricular fibrillation as seen in the IEGM
Figure 3. Episode of NSVT causing presyncope
