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