DR-FLASH score for arrhythmogenic left atrial substrate

DR-FLASH score for arrhythmogenic left atrial substrate

DR-FLASH score is based on diabetes mellitus, renal dysfunction, persistent form of AF (atrial fibrillation), LA (left atrial) diameter  above 45 mm, age above 65 years, female sex, and hypertension. It was developed as a clinical  for left atrial arrhythmogenic substrate based on voltage analysis [1]. Left atrial low voltage areas noted in patients with AF may predict recurrence after ablation, hence the need for the score. The probability for the presence of left atrial substrate requiring additional ablation other than the routine pulmonary vein isolation done for AF ablation, increased by a factor of 2.2 with each extra point in the score. Risk of recurrence after pulmonary vein isolation for AF was 2 times higher in those with a DR-FLASH score above 3.

APPLE score is another which has been developed to predict left atrial low voltage areas. One point each is given for Age above 65 years, Persistent AF, imPaired eGFR below 60 mL/min/1.73 m2, Left atrial diameter of 43 mm or more, Ejection fraction less than 50% [2].

Reference

  1. 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. Prospective, multicenter validation of a clinical risk score for left atrial arrhythmogenic substrate based on voltage analysis: DR-FLASH score. Heart Rhythm. 2015 Nov;12(11):2207-12.
  2. Kornej J, Büttner P, Sommer P, Dagres N, Dinov B, Schumacher K, Bollmann A, Hindricks G. Prediction of electro-anatomical substrate using APPLE score and biomarkers. Europace. 2019 Jan 1;21(1):54-59.