A novel pulmonary vein potential mimic unique to cryoballoon ablation of atrial fibrillation
Bibliographic record
Abstract
Phrenic nerve (PN) injury is the most frequently observed complication of cryoballoon pulmonary vein (PV) ablation.1,2 We recently described a novel approach involving the use of diaphragmatic electromyography to reduce PN injury whereby a reproducible supramaximal diaphragmatic compound motor action potential (CMAP) can be reliably recorded on a surface electrode during continuous PN pacing.3 The figure demonstrates a tracing during cryoballoon ablation of the right inferior pulmonary vein (RIPV). The 28 mm cryoballoon catheter is positioned at the RIPV ostium. A 20 mm Achieve circular mapping catheter (CMC) is positioned distally in the RIPV to ensure catheter stability and optimize PV ostium–cryoballoon contact. During ablation the PN was continuously stimulated from a quadripolar catheter positioned in the superior vena cava (1000 ms; 10 mA; 1 ms) resulting in the recording of a surface diaphragmatic CMAP (PHREN2). A signal associated with, yet distinct from, the pacing artefact was recorded on the CMC (PV 1,2 to 8,1; *). This signal was dissociated from the far-field atrial (α) and ventricular electrograms (β) yet simultaneous to the surface CMAP. Although PV potentials were recorded proximally at the PV ostium there were no pulmonary vein potential (PVPs) recorded in this very distal position. While mimicking the appearance of a PVP this signal is intrathoracic representation of the diaphragmatic CMAP as elicited by PN pacing. It is important to recognize that the possibility for recording diaphragmatic potentials with very distal CMC positions exists. Differentiation of diaphragmatic CMAPs from PVPs is important in the avoidance of unnecessary right-sided cryoapplications and PN injury. The full-length version of this report can be viewed at: http://www.escardio.org/communities/EHRA/publications/ep-case-reports/Documents/pvp-mimic-cryoballoon-ablation.pdf
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".