Characterizing fast pathway in typical and atypical atrioventricular nodal re-entrant tachycardia by atrial-His and His-atrial: more to consider
Notice bibliographique
Résumé
We read with interest the paper by Katritsis et al.1 published in Europace recently. In this study, the authors sought to assess the prevalence, electrophysiological characteristics, and mechanism underlying atypical atrioventricular nodal re-entrant tachycardia (AVNRT), which is not clinically well-defined. It was shown that the atrial-His (AH) interval in atypical ‘fast-slow’ (F-S) AVNRT is longer than His-atrial (HA) interval in typical ‘slow-fast’ (S-F) AVNRT, implying that different fast conduction pathways are utilized in these two types of tachycardia. However, we are holding the following interpretations: First of all, we noticed that the earliest retrograde atrial activities were obviously different between F-S AVNRT and S-F AVNRT patients. In F-S patients, the earliest atrial activities were mostly (∼60%) at proximal coronary sinus (pCS), while the earliest atrial activities in S-F patients were predominantly (∼85%) appeared at the His region. It has been previously shown that different fibre connections exist between atria and AVN in typical S-F AVNRT resulting in a different retrograde atrial activation of the fast pathway.2 The different patterns of atrial activation may cause an alternate conduction time from AVN to atrium, and such a difference will potentially bring in more variable atrial intervals within each group that could influence interpreting the comparison of AH and HA interval further. Furthermore, it is also necessary to understand whether those patients with a similar atrial activity sequence are utilizing the same fast pathway during tachycardia. Hence, we are wondering whether it would be worthy to analyse the patients with an identical atrial activity in these two types of tachycardia separately, in other words, comparing the F-S and S-F types of patients with the earliest pCS atrial activity as well as comparing those with earliest His regional atrial activity. Secondly, the authors made the assumption that the conduction velocity over the fast pathway is similar in the anterograde and retrograde directions. However, it has previously been shown3 that the anterograde and retrograde conduction time of the AVN are different, which means that the Fretro and Fante would differ from each other even if they were using the same fast pathway. This could make the interpretation of the results more complicated, impacting both the estimated prevalence and mechanistic characterization of atypical AVNRT. Further challenges in characterizing atypical AVNRT remain, including difficulties associated with detailing the small area of Triangle of Koch and the direct recording of conduction or activity in the AVN. Nevertheless, the present study has provided new insight into the prevalence and mechanistic basis of atypical ANVRT which will be invaluable for its clinical interpretation moving forward.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,014 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,003 |
| Communication savante | 0,003 | 0,005 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,013 | 0,011 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».