Prediction of Pacemaker Requirement in Patients With Unexplained Syncope: The DROP Score

Area of Science:

• Cardiology
• Electrophysiology

Background:

• Implantable loop recorders (ILR) are used for unexplained syncope but are costly and do not prevent future events.
• Identifying patients who will benefit from permanent pacemaker (PPM) implantation is crucial.

Purpose of the Study:

• To compare patients requiring PPM after ILR with those who did not.
• To identify predictors for upfront pacing in unexplained syncope.

Main Methods:

• Analysis of 100 patients with ILR, divided into two groups: 50 receiving PPM and 50 with no detected arrhythmias.
• Assessment of clinical characteristics, syncope history, ECG, and echocardiographic parameters.
• Development of the DROP score based on significant univariate predictors.

Main Results:

• Patients requiring PPM were older and less likely to have syncope triggers.
• Distal conduction disease, first-degree AV block, absence of triggers, and age >65 predicted PPM need.
• The DROP score effectively predicted pacing requirement, with scores of 3-4 strongly indicating need.

Conclusions:

• The DROP score shows potential for guiding decisions on upfront PPM insertion in unexplained syncope.
• Further prospective studies are needed to validate the DROP score's utility.