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Prospective, multicenter validation of a clinical risk score for left atrial arrhythmogenic substrate based on voltage analysis: DR-FLASH score.

Abstract：

BACKGROUND:Left atrial (LA) low-voltage areas (LVAs) are frequently observed in patients with atrial fibrillation (AF) and may predict AF recurrence after catheter ablation. OBJECTIVE:The aim of this study was to develop and validate a clinical tool to identify LVAs that are associated with AF recurrence after pulmonary vein isolation (PVI). METHODS:In a cohort of 238 patients, voltage maps were created during LA procedures. LVAs were defined as areas with electrogram amplitudes <0.5 mV. On the basis of regression analysis, predictors of LA substrate were identified. These parameters were used to establish a dedicated risk score (DR-FLASH score, based on diabetes mellitus, renal dysfunction, persistent form of AF, LA diameter >45 mm, age >65 years, female sex, and hypertension). This risk score was then prospectively validated in a multicenter cohort of 180 patients. The association of the score with long-term recurrence of atrial arrhythmias after circumferential PVI was tested in a retrospective cohort of 484 patients. RESULTS:The DR-FLASH score effectively identified LVA substrate (C statistic = 0.801, P < .001). In the prospective multicenter validation cohort, the predictive value of the DR-FLASH score was confirmed (C statistic = 0.767, P < .001). The probability for the presence of LA substrate increased by a factor of 2.2 (95% confidence interval [CI] 1.6-2.9, P < .001) with each point scored. Furthermore, the risk of AF recurrence after PVI increased by a factor of 1.3 (95% CI 1.1-1.5, P < .001) with every additional point and was almost 2 times higher in patients with a DR-FLASH score >3 (odds ratio 1.7, 95% CI 1.1-2.8, P = .026). CONCLUSION:The DR-FLASH score may be useful to identify patients who may require extensive substrate modification instead of PVI alone.

journal_name

Heart Rhythm

journal_title

Heart rhythm

authors

Kosiuk J,Dinov B,Kornej J,Acou WJ,Schönbauer R,Fiedler L,Buchta P,Myrda K,Gąsior M,Poloński L,Kircher S,Arya A,Sommer P,Bollmann A,Hindricks G,Rolf S

doi

10.1016/j.hrthm.2015.07.003

subject

Has Abstract

pub_date

2015-11-01 00:00:00

pages

2207-12

issue

11

eissn

1547-5271

issn

1556-3871

pii

S1547-5271(15)00885-1

journal_volume

12

pub_type

杂志文章,多中心研究

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