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An 81 year old male with severe aortic stenosis, dialysis dependency and prior bypass surgery underwent transcatheter aortic valve replacement (TAVR). The procedural course was complicated by development of complete heart block ultimately requiring placement of a leadless pacemaker due to vascular access issues from the upper extremities. Fluoroscopy is presented demonstrating simultaneous old and new medical technologies. Etiology, risk factors and implications of post-TAVR heart block are reviewed.

“Old and New”: Novel and Traditional Medical Technologies in Juxtaposition