Catheter Ablation -> Ventricular Arrhythmias -> Quality Measures & Complications D-PO06 - Poster Session VI (ID 26) Poster

D-PO06-116 - Ventricular Tachycardia: An Underappreciated Complication Following Transcatheter Aortic Valve Replacement (ID 675)


Background: Conduction abnormalities are a well-described complication after transcatheter aortic valve replacement (TAVR). While preliminary studies suggest benefit of TAVR with regards to reduction in burden of pre-existing ventricular arrhythmia (VA), little is known about the incidence of de novo VA after TAVR.
Objective: We sought to identify incidence and mechanisms of new VAs in patients who underwent TAVR at our institution.
Methods: We retrospectively identified patients between 1/2013 and 8/2019 who had new VAs identified on routine ambulatory monitor within 30 days after TAVR. Clinical and VA characteristics were recorded.
Results: Among 715 patients who underwent TAVR at our institution, 5 (0.7%) developed symptomatic VAs after TAVR. Mean age was 71 (SD 4.6), 80% were male, and mean LVEF was 60% (SD 15%). All 5 patients had been treated with balloon expandable valves. VAs included premature ventricular contractions or nonsustained ventricular tachycardia (PVCs/NSVT) in 2 (40%) and sustained VT in 3 (60%) patients. Both PVC/NSVT patients developed tachycardia-mediated cardiomyopathy. In both, PVC exits were mapped to the LV summit region adjacent to TAVR struts and ablated successfully. Among the 3 patients who developed sustained VT, 1 died suddenly (with VT recorded on outpatient monitor), 1 was treated with amiodarone at an outside facility, and one underwent uncomplicated catheter ablation of bundle branch reentrant VT.
Conclusion: De novo symptomatic ventricular arrhythmia is an underrecognized phenomenon following TAVR. Catheter ablation is a feasible treatment option. Future analyses should focus on quantifying the prevalence and severity of these VAs.