{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T19:13:08Z","timestamp":1791400388441,"version":"4.3.3"},"reference-count":44,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"16","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2022,8,16]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Modification of arrhythmogenic substrates with extensive ablation comprising linear and\/or complex fractional atrial electrogram ablation in addition to pulmonary vein isolation (PVI\u2010plus) can theoretically reduce the recurrence of atrial fibrillation. The DR\u2010FLASH score (score based on diabetes mellitus, renal dysfunction, persistent form of atrial fibrillation, left atrialdiameter &gt;45 mm, age &gt;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\u2010FLASH score can be used to classify patients into those who require PVI\u2010plus and those for whom a PVI\u2010only strategy is sufficient.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      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\u2010PVI trial). This analysis focuses on the relationship between DR\u2010FLASH score and the efficacy of different ablation strategies. We divided the population into 2 groups based on a DR\u2010FLASH score of 3 points. A total of 469 patients were analyzed. Among those with a DR\u2010FLASH score &gt;3 (N=279), the event rate of atrial arrhythmia recurrence was significantly lower in the PVI\u2010plus arm than in the PVI\u2010only arm (hazard ratio [HR], 0.45 [95% CI, 0.28\u20130.72];\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001). In contrast, among patients with a DR\u2010FLASH score \u22643 (N=217), no differences were observed in the event rate of atrial arrhythmia recurrence between the PVI\u2010only arm and the PVI\u2010plus arm (HR, 1.08 [95% CI, 0.61\u20131.89];\n                      <jats:italic>P<\/jats:italic>\n                      =0.795). There was significant interaction between patients with a DR\u2010FLASH score &gt;3 and DR\u2010FLASH score \u22643 (\n                      <jats:italic>P<\/jats:italic>\n                      value for interaction=0.020).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">The DR\u2010FLASH score is a useful tool for deciding the catheter ablation strategy for patients with persistent atrial fibrillation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Registration<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\">https:\/\/clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT03514693.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.121.024916","type":"journal-article","created":{"date-parts":[[2022,8,5]],"date-time":"2022-08-05T05:18:13Z","timestamp":1659676693000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":23,"title":["DR\u2010FLASH Score Is Useful for Identifying Patients With Persistent Atrial Fibrillation Who Require Extensive Catheter Ablation Procedures"],"prefix":"10.1161","volume":"11","author":[{"given":"Taiki","family":"Sato","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine Osaka University Graduate School of Medicine Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yohei","family":"Sotomi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Osaka University Graduate School of Medicine Osaka 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