BRUGADA PATTERN AND CARDIAC ARREST: A RARE COMPLICATION FOLLOWING TRANSCATHETER AORTIC VALVE REPLACEMENT

Document Type

Article

Publication Date

3-2019

Publication Title

Journal of the American College of Cardiology

Abstract

Background: Cardiac arrest is a rare but feared complication of transcatheter aortic valve replacement (TAVR). It is known to be caused by ventricular arrhythmias, complete heart block or acute coronary occlusion related to the procedure. Successful resuscitation and treatment requires knowledge and prompt diagnosis of the possible causes of cardiac arrest after TAVR. Case: An 83 year old man with known coronary disease underwent successful TAVR, then later that evening suffered a cardiac arrest with ventricular fibrillation as the initial rhythm. After resuscitation, electrocardiography showed ST elevations in leads v1 and v2, consistent with Brugada Pattern Type I with prolonged QT(Figure 1). Decision-making: Given his history, urgent cardiac catheterization was performed and showed non-obstructive disease. Electrolytes were normal. Echocardiography showed normal position and function of the new valve. His medications included recent anesthesia and multiple home medications that are known to unmask an underlying Brugada Syndrome or prolong the QT interval. His medications were adjusted and an implantable cardioverter-defibrillator was placed for secondary prevention. He declined a formal electrophysiology study. Conclusion: This case highlights the various causes, evaluation and treatment of ventricular fibrillation following TAVR. It also shows the importance of a thorough history including medication review and close perioperative rhythm monitoring for all TAVR patients.

Volume

73

Issue

9 Supplement 1

First Page

2647

Last Page

2647

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