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Post-TAVI Conduction Abnormality — RACP Adult Medicine MCQ

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ModerateCardiologyPost-TAVI Conduction AbnormalityRACP Adult Medicine

A 70-year-old man with known aortic stenosis develops syncope during a Valsalva manoeuvre. His echocardiogram shows a peak aortic valve velocity of 5.2 m/s. He undergoes transcatheter aortic valve implantation (TAVI). Two days post-procedure, he develops a new complete heart block. What is the most common conduction abnormality after TAVI?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — New left bundle branch block

New LBBB is the most common conduction abnormality after TAVI, occurring in 15–25% of patients (higher with self-expanding valves). Complete heart block requiring permanent pacemaker occurs in 10–20%. The mechanism is mechanical compression of the His bundle and left bundle branch by the prosthetic valve frame at the level of the membranous septum. Pre-existing RBBB is a risk factor for complete heart block post-TAVI.

Reference: CSANZ – 2022 – TAVI Guidelines; ESC – 2021 – Valvular Heart Disease