Electrophysiology And Arrhythmia Scores

PAAINESD Score Calculator – VT Ablation Hemodynamic Risk

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Hemodynamic Risk Assessment

Select the preprocedural and planned procedural characteristics that apply to the patient undergoing scar-related VT ablation.

—PAAINESD
P

Pulmonary disease (COPD)

History of chronic obstructive pulmonary disease.

+5 points
A

Age >60 years

Patient age is strictly greater than 60 years.

+3 points
A

General anesthesia

General anesthesia planned for the ablation procedure. This is the additional PAAINESD component; it is excluded from the original PAINESD score.

+4 points
I

Ischemic cardiomyopathy

Underlying ischemic cardiomyopathy.

+6 points
N

NYHA functional class III or IV

New York Heart Association functional class III or IV.

+6 points
E

Left ventricular ejection fraction <25%

LVEF is strictly below 25%.

+3 points
S

VT storm

Presentation with ventricular tachycardia storm.

+5 points
D

Diabetes mellitus

History of diabetes mellitus.

+3 points
—PAAINESD
PAAINESD high-risk threshold
Assessment incomplete
Select Yes or No for all eight variables. Unanswered variables are not assumed to be absent.
PAAINESD (including anesthesia)— / 35
PAINESD (excluding anesthesia)— / 31
Clinical contextComplete every item to calculate the PAAINESD and PAINESD totals.

About the PAAINESD Score

The PAAINESD score is a clinical risk stratification tool intended to identify patients with structural heart disease undergoing scar-related ventricular tachycardia (VT) ablation who may be at increased risk of periprocedural acute hemodynamic decompensation (AHD).

The original PAINESD score contains seven variables and ranges from 0 to 31. The PAAINESD version adds planned general anesthesia (+4 points), resulting in a maximum score of 35.

Variables and Points

VariableCriterionPoints
Pulmonary diseaseCOPD5
Age>60 years3
General anesthesiaPlanned general anesthesia4
Ischemic cardiomyopathyPresent6
NYHA classIII or IV6
LVEF<25%3
VT stormPresent5
Diabetes mellitusPresent3

Risk thresholds and interpretation

With general anesthesia included: a PAAINESD score ≥17 has been cited as identifying a particularly high-risk group. The consensus statement describes the high-risk threshold as approximately 15–17 depending on whether general anesthesia is included.

Without general anesthesia: in the original PAINESD development cohort, the reported tertiles were ≤8 points (1% AHD), 9–14 points (6% AHD), and ≥15 points (24% AHD). These are cohort-derived estimates and should not be assumed to represent contemporary individualized probabilities.

The calculator displays both totals to make the anesthesia component transparent. It does not convert the PAAINESD total into an absolute probability because a directly validated probability mapping for every score value is not established here.

References

Santangeli P, Muser D, Zado ES, et al.Acute hemodynamic decompensation during catheter ablation of scar-related ventricular tachycardia: incidence, predictors, and impact on mortality. Circ Arrhythm Electrophysiol. 2015;8(1):68–75. DOI: 10.1161/CIRCEP.114.002155.
Cronin EM, Bogun FM, Maury P, et al.2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. J Arrhythm. 2019;35(3):323–484. DOI: 10.1002/joa3.12185.
Identifying Risk and Management of Acute Haemodynamic Decompensation During Catheter Ablation of Ventricular Tachycardia.Arrhythmia & Electrophysiology Review. 2019. DOI: 10.15420/aer.2018.36.3.
Periprocedural acute haemodynamic decompensation during substrate-based ablation of scar-related ventricular tachycardia: a rare and unpredictable event.Europace. 2024;26(6):euae145. DOI: 10.1093/europace/euae145. This cohort reported that PAINESD did not predict AHD in a predominantly substrate-based, conscious-sedation population.
Clinical disclaimer: This calculator supports preprocedural risk assessment and is not a substitute for clinical judgment. The PAINESD/PAAINESD score has limitations, and its performance may vary with patient selection, ablation strategy, anesthesia practice, and center-specific procedural protocols. A high score alone should not be treated as an automatic indication for mechanical circulatory support. Interpret results alongside the full clinical context and current institutional practice.
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