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Risk Score of Koplan et al for Needing a Permanent Pacemaker After Cardiac Valve Surgery

Purpose: To identify a patient undergoing cardiac valve surgery who may require permanent pacing after surgery.

Description

Koplan et al developed a simple risk score for predicting the need for permanent pacemaker placement after cardiac valve surgery. The score uses factors that are all known prior to surgery. The authors are from Brigham and Women's Hospital in Boston.


Parameters:

(1) right bundle branch block on pre-operative ECG

(2) right bundle branch block on pre-operative ECG

(3) right bundle branch block on pre-operative ECG

(4) multivalve surgery with or without involving the tricuspid valve

(5) age

(6) history of previous cardiac valve surgery

 

Parameter

Finding

Points

right bundle block on pre-operative ECG

absent

0

 

present

2

left bundle block on pre-operative ECG

absent

0

 

present

1

PR interval on pre-operative ECG

<= 200 milliseconds

0

 

> 200 milliseconds

1

valve surgery

single valve

0

 

multivalve, not involving the tricuspid valve

1

 

multivalve, involving the tricuspid valve

2

age of the patient

< 70 years

0

 

>= 70 years

1

history of previous valve surgery

no

0

 

yes

1

 

total risk score =

= SUM(points for all 6 parameters)

 

Interpretation:

• minimum score: 0 points

• maximum score: 8 points (by my count)

• The paper says the maximum score is 7 on page 798. This could be achieved if only a single point assignment was made for left and/or right bundle branch block.

 

Risk Score

Risk Group

Percent Requiring a Post-Operative Pacemaker

0 or 1

low

3.6%

2 or 3

moderate

9.8%

>= 4

high

25%

 


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Specialty

Objective

ICD-10