DR‐FLASH Score Is Useful for Identifying Patients With Persistent Atrial Fibrillation Who Require Extensive Catheter Ablation Procedures
Authors: Sato Taiki , Sotomi Yohei , Hikoso Shungo , Nakatani Daisaku , Mizuno Hiroya , Okada Katsuki , Dohi Tomoharu , Kitamura Tetsuhisa , Sunaga Akihiro , Kida Hirota , Oeun Bolrathanak , Egami Yasuyuki , Watanabe Tetsuya , Minamiguchi Hitoshi , Miyoshi Miwa , Tanaka Nobuaki , Oka Takafumi , Okada Masato , Kanda Takashi , Matsuda Yasuhiro , Kawasaki Masato , Masuda Masaharu , Inoue Koichi , Sakata Yasushi , Mano Toshiaki , Masuda Masaharu , Kanda Takashi , Matsuda Yasuhiro , Fukunami Masatake , Yamada Takahisa , Watanabe Tetsuya , Furukawa Yoshio , Kawasaki Masato , Hasegawa Shinji , Miyoshi Miwa , Higuchi Yoshiharu , Makino Nobuhiko , Minamiguchi Hitoshi , Hirata Akio , Tanouchi Jun , Nishino Masami , Matsunaga Yasuharu , Egami Yasuyuki , Sakata Yasushi , Matsumura Yasushi , Hikoso Shungo , Nakatani Daisaku , Mizuno Hiroya , Takeda Toshihiro , Oka Takafumi , Nakano Tomoaki , Ozu Kentaro , Suna Shinichiro , Okada Katsuki , Dohi Tomoharu , Sotomi Yohei , Sunaga Akihiro , Kida Hirota , Oeun Bolrathanak , Sato Taiki , Inoue Koichi , Tanaka Koji , Tanaka Nobuaki , Minamisaka Tomoko , Hoshida Shiro 
Published: August 2022

Background
Modification of arrhythmogenic substrates with extensive ablation comprising linear and/or complex fractional atrial electrogram ablation in addition to pulmonary vein isolation (PVI‐plus) can theoretically reduce the recurrence of atrial fibrillation. The DR‐FLASH score (score based on diabetes mellitus, renal dysfunction, persistent form of atrial fibrillation, left atrialdiameter >45 mm, age >65 years, female sex, and hypertension) is reportedly useful for identifying patients with arrhythmogenic substrates. We hypothesized that, in patients with persistent atrial fibrillation, the DR‐FLASH score can be used to classify patients into those who require PVI‐plus and those for whom a PVI‐only strategy is sufficient.

Methods and Results

This study is a post hoc subanalysis of the a multicenter, randomized controlled, noninferiority trial investigating efficacy and safety of pulmonary vein isolation alone for recurrence prevention compared with extensive ablation in patients with persistent atrial fibrillation (EARNEST‐PVI trial). This analysis focuses on the relationship between DR‐FLASH score and the efficacy of different ablation strategies. We divided the population into 2 groups based on a DR‐FLASH score of 3 points. A total of 469 patients were analyzed. Among those with a DR‐FLASH score >3 (N=279), the event rate of atrial arrhythmia recurrence was significantly lower in the PVI‐plus arm than in the PVI‐only arm (hazard ratio [HR], 0.45 [95% CI, 0.28–0.72];
P
<0.001). In contrast, among patients with a DR‐FLASH score ≤3 (N=217), no differences were observed in the event rate of atrial arrhythmia recurrence between the PVI‐only arm and the PVI‐plus arm (HR, 1.08 [95% CI, 0.61–1.89];
P
=0.795). There was significant interaction between patients with a DR‐FLASH score >3 and DR‐FLASH score ≤3 (
P
value for interaction=0.020).

Conclusions
The DR‐FLASH score is a useful tool for deciding the catheter ablation strategy for patients with persistent atrial fibrillation.

Registration

URL:
https://clinicaltrials.gov
; Unique identifier: NCT03514693.