Abstract 16688: Calculating the Probability of Presence of Left Atrial Arrhythmogenic Substrate: Dr-Flash Score
Background: Presence of left atrial (LA) low-voltage areas is frequently observed in patients with persistent atrial fibrillation (AF) and possibly represent substrate for extra-pulmonary veins triggered arrhythmias. Here, we present for the first time the Dr-FLASH Score aiming to calculate the probability of the presence of LA arrhythmogenic substrate.
Methods: In a cohort of 238 consecutive patients undergoing a AF ablation a high-density voltage maps using ablation catheters as roving catheter were created. LA potentials with amplitude over 0.5 mV were defined as normal, and potentials under 0.2 mV as scar. From the baseline characteristics, echocardiographic and laboratory parameters substrate’s predictors were identify and used to build a score by assigning 1 point for each quality.
Results: Out of 238 patients (mean age 61 ± 10 years, 76% male) with paroxysmal (n=86) or persistent AF (n=152) referred for AF catheter ablation, LA substrate was identify in 66 patients (28%). Patients with LA substrate were older (>65 in 67% vs. 28%, p45mm in 53% vs. 32%, p=0.003) and impaired kidney function (GFR<90mg/dL in 89% vs. 64%, p<0.001). The calculated Dr-FLASH score (Diabetes, impaired Renal function with GFR<90mg/d, persistent Form of AF, LA>45mm, Age>65Y, female Sex, Hypertension) ranging from 0-7, was highly effective in identifying the patients with LA substrate (C-statistic, 0.810). The probability of presence of substrate increased by a factor of 2.5 (95%CI, 1.9-3.3) for each 1-point increase.
Conclusions: Our novel score is a reliable tool to identify patients with LA arrhythmogenic substrate and therefore may be used to guide approach of invasive AF treatment and patients selection.
- © 2013 by American Heart Association, Inc.