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% |
Purpose: To identify a patient undergoing cardiac valve surgery who may require permanent pacing after surgery.
Specialty: Cardiology
Objective: risk factors, imaging studies, severity, prognosis, stage, selection
ICD-10: Z95.0,