Iatrogenic Left Ventricle Outflow Tract Ventricular Tachycardia Following Transcatheter Aortic Valve Replacement: A Case Series

Abstract

Abstract Background: Focal left ventricular outflow tract ventricular tachycardia (LVOT-VT) has been rarely reported following transcatheter aortic valve replacement (TAVR). Case Presentation: Our first case is a 70-year-old man with bicuspid aortic valve (Sievers type 0) who was found to have severe aortic valve stenosis and underwent uncomplicated transfemoral TAVR with 26-mm Edwards SAPIEN-3 Ultra valve. Five months later, he presented to emergency room with dizziness and dyspnea. ECG suggested VT of LVOT origin. Cardiac MRI revealed no fibrosis. Patient was treated with amiodarone with suppression of VT. Our second case is of an 80-year-old man who was diagnosed with symptomatic severe aortic stenosis. He also underwent transfemoral TAVR with 26-mm Edwards SAPIEN-3 Ultra valve. He had complete heart block postoperatively, necessitating a pacemaker. Twelve hours later, he suffered sustained VT of one hour duration, morphology suggestive of LVOT on ECG. Coronary angiography showed patent coronary arteries. He was also managed with amiodarone with suppression of VT. Conclusions: LVOT-VT following TAVR may be secondary to disease process affecting the valve and adjacent area, direct mechanical pressure of valve stent against LVOT, change in LVOT geometry, periaortic scar or yet unknown mechanism from an unrelated substrate. Unexplained sudden cardiac death after TAVR may be attributable to VT; hence it is important to be aware of this rare association.