Case 150: A 76 Year-Old Woman Seen in the Structural Heart Clinic
History
Diagnosis
ECG 2
ECG 2 Diagnosis
ECG 3
ECG 3 Diagnosis
ECG 4
ECG 4 Diagnosis
History
A 76yr woman with severe symptomatic aortic stenosis is seen in the structural heart clinic. Her baseline ECG is shown below:
Diagnosis
- Sinus rhythm, 65/min
- Non-specific inferior ST abnormality
- Anterolateral ST-T abnormality – cannot rule out ischemia
ECG 2
The patient undergoes transcatheter aortic valve replacement (TAVR) without immediate complication. Her post procedure ECG is shown below:
ECG 2 Diagnosis
Comment: Damage to the AV node and/or His Purkinje system is a common complication of TAVR. Because this patient developed LBBB she was kept in hospital for further observation.
ECG 3
Two days post TAVR, the following ECG is recorded:
ECG 3 Diagnosis
- Sinus rhythm, 84/min (P-waves shown with arrows)
- Prolonged 1st degree AV block (PR=520ms)
- Left Bundle Branch Block Pattern
ECG 4
Three days post TAVR, the following ECG is recorded
ECG 4 Diagnosis
- Sinus rhythm, 80/min (P-waves shown with arrows)
- 2:1 AV block with prolonged 1st degree AV block on conducted beats
- Left Bundle Branch Block Pattern
Comment: Because of the progressive worsening AV nodal conduction, the patient received a dual chamber pacemaker.
ECG ID: E827