Bibliographic record
Abstract
Should Catheter Ablation Be Indicated Onlyfor Symptom-Relief of AF?Atrial fibrillation (AF) is the most common arrhythmia, particularly in seniors, with an incidence of 4% after the age of 65 with the figure doubling with every 10 years of age.][3] Persistence of left atrial (LA) volume and pressure overloading during AF due to loss of atrial contraction, shortened diastolic ventricular filling and atrio-ventricular valvular regurgitation leads to atrial anatomical and electrical remodeling which further facilitates persistence of AF. 4) Canadian Registry of AF reported that the probability of progression of paroxysmal AF (PAF) to chronic AF (CAF) (defined as AF on 2 consecutive electrocardiograms separated by ! 1 week) was 8.6% by 1 year. 5)This malignant cycle should be interrupted immediately by restoration and longlasting maintenance of sinus rhythm (SR).New on-treatment analysis of the AFFIRM study revealed that presence of SR was associated with a 47% reduction of death and use of antiarrhythmic drugs (AAD) was associated with significant increase of mortality by 49%. 6) This suggests favorable AAD effect for AF termination might be offset by its potentially life-threatening adverse effects, and minimally invasive non-pharmacological treatment without acceptable risks, i.e. catheter ablation (CA), must be considered first-line therapy.Superiority of catheter ablation (CA) to AAD in AF rhythm control has been shown by recent meta-analyses.The recent meta-analysis of randomized, controlled trials comparing pulmonary vein isolation and medical therapy by Piccini et al 7) showed markedly higher AF-free survival rate at 1 year in CA (77% vs 29%).According to another meta-analysis by Calkins et al, 8) multiple CA showed higher efficacy of CA (71% vs 52%) and also a lower rate of adverse effects (5% vs 30%).As the above shows, CA appears to have an acceptable efficacy and risk of major complication without any equivalent minimally invasive alternative therapy for treatment of AF.However, HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of AF 9) published in 2007 stated that the primary selection of CA is symptomatic AF refractory or intolerant to at least one Class 1 or 3 AAD, and recent ESC guidelines 10) published in 2010 also stated CA as first-line therapy is a Class IIb recommendation for patients with paroxysmal AF with no or minimal heart disease, who remain highly symptomatic despite rate control and who reject AAD therapy, otherwise for drugrefractory and symptomatic paroxysmal and persistent AF have second-line indication with Class IIa and IIb recommendation, respectively.In these guidelines, CA is officially unjustifiable for asymptomatic AF because of the potential risk of major complications, even if their incidences are recognized to be very low.However, there is increasing evidence that restoration and maintenance of SR confers benefits as a consequence of reverse electrical and anatomical remodeling of the atrium and ventricle.The ongoing CABANA (Catheter Ablation vs Antiarrhythmic Drug therapy for AF) Trial conducted by Packer DL et al, 11) which is designed to investigate the impact of CA for AF on survival with a primary endpoint of all-cause mortality, a planned recruitment of 3000 patients and a follow-up period of 3.5 years, might be anticipated to show evidence of CA as a promising first-line therapy for AF.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.012 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.006 | 0.005 |
| Insufficient payload (model declined to judge) | 0.008 | 0.002 |
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 source (direct Gemma or distilled Codex), 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".