Cause of complete atrioventricular block after percutaneous aortic valve implantation: insights from a necropsy study.

Transcatheter aortic valve implantation is being established as an alternative treatment for some patients with symptomatic severe aortic stenosis who are not considered suitable for surgical aortic valve replacement because of prohibitive surgical risk.1–3 One of the potential complications is complete atrioventricular block requiring definitive pacemaker implantation. This complication occurs in 4% to 5% with the Edwards-Sapiens prosthesis (Edwards Lifesciences, Irvine, Calif),1 and in 30% with the CoreValve system (Medtronic CV, Luxembourg),3 but it also occurs in 5% of patients after percutaneous aortic valvuloplasty4 or surgical aortic valve replacement.5 The cause of complete atrioventricular block after transcatheter aortic valve implantation is unknown. Apart from traumatic lesions produced by aortic valve prosthesis expansion, ischemia of the conduction pathways resulting from insufficient myocardial protection might play a role. Here, necropsy findings in a patient with complete atrioventricular block after transcatheter aortic valve implantation are presented for the first time, showing the physiopathology of this complication. A 79-year-old woman with symptomatic severe aortic stenosis and prohibitive surgical risk was referred for transcatheter aortic valve implantation. A 26-mm EdwardsSapiens prosthetic valve was implanted without complications except complete atrioventricular block requiring transvenous pacemaker stimulation. Three days after transcatheter aortic valve implantation, the patient suffered sudden cardiac death that could not be resolved with resuscitation. Necropsy was performed to evaluate the status of the pros-