Successful treatment of a post-TAVR left bundle branch block and transient AV block with a stylet-driven lead and left bundle branch pacing

Transcatheter aortic valve replacement (TAVR) is frequently associated with the development of new-onset disturbances in the cardiac conduction system. Despite resolving the underlying valvular disease, reverse cardiac remodeling is impeded by high pacing rates due to atrioventricular (AV) conduction disorders or left bundle branch block (LBBB), potentially leading to poorer long-term outcomes. Left bundle branch pacing (LBBP) may prove beneficial in further improving outcomes in selected patients. We present the case of an 80-year-old man with severe symptomatic aortic stenosis, preserved left ventricular ejection fraction, and a narrow intrinsic QRS complex who underwent TAVR at our institution. Following the implantation of a self-expanding valve, the patient developed LBBB and experienced episodes of transient AV block. We implanted a pacing lead to capture the left bundle branch to address this. Using a customized sheath, a stylet-driven lead was positioned deep in the interventricular septum. Selective left bundle branch pacing (paced QRS duration: 120 ms) was successfully achieved with excellent threshold parameters. No complications occurred; the patient was discharged home the following day. This case illustrates that distal, post-TAVR AV block can be effectively corrected with LBBP while simultaneously optimizing intraventricular conduction.