Score of Roca-Luque for Identifying a Patient with Syncope Who Is At Risk for Advanced Atrioventricular Block After a Negative Electrophysiological Test
Some patients with syncope have a disorder of cardiac conduction and benefit from implantation of a pacemaker. Electrophysiological testing can miss some patients at risk of developing advanced atrioventricular block (false negative). Roca-Luque et al report a simple score for identifying patients who may need a pacemaker. The authors are from Hospital Universitari Vall d'Hebron in Barcelona.
Patient selection: syncope with negative electrophysiological test
Parameters:
(1) His-ventricular (HV) interval in milliseconds
(2) bifascicular block
Parameter
Finding
Points
His-ventricular interval
< 60 ms
0
>= 60 ms
4
bifascicular block
absent
0
present
6
total score =
= SUM(points for the 2 parameters)
Interpretation:
• minimum score: 0
• maximum score: 10
• The higher the score the greater the risk of eventually needing a pacemaker.
• An implantable loop recorder is inserted in patients not given a pacemaker. This is activated after a syncopal attack.
Total Score
Risk Group
Percent Eventually Needing a Pacemaker
0
low
14%
4
medium
33%
6 or 10
high
67%
Alternatively, this can be replaced by rules:
If there is bifascicular block, then high risk.
If not high risk and if HV interval >= 60 ms then medium risk.
Else low risk.
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