Elimination of cavotricuspid isthmus conduction by a single ablation lesion: observations from a maximum voltage-guided ablation technique
Bibliographic record
Abstract
AIMS: The architecture of the cavotricuspid isthmus has been shown to be highly variable made of a large number of interspersed bundles in the majority. Targeting high-amplitude signals has resulted in short-ablation times, likely due to the selective ablation of such bundles. We report a series of cases where a single site ablation resulted in bidirectional block, supporting the hypothesis that conduction can occur over a discrete portion of the isthmus. METHODS AND RESULTS: Sixty consecutive patients underwent ablation for isthmus-dependent atrial flutter using voltage-guided approach between September 2005 and June 2006. We found in five patients (8.3%) (four male, mean age 58.1 +/- 11.4 years), in whom bidirectional block was achieved by ablation at a single site. The isthmus was mapped at the 6 o'clock LAO position, and bipolar amplitude was measured during pull-back to find the site of largest atrial voltage. The atrial and ventricular electrogram (EGM) measured 2.00 +/- 1.6 and 0.2 +/- 0.1 mV, respectively, at the successful site, resulting in the mean atrium/ventricle ratio of 9.1 +/- 4.1. The total radiofrequency time was 83.8 +/- 25.3 s, and the procedure time was 68.6 +/- 10.4 min, including 30 min waiting time after the procedure. Flutter has not recurred over 5.7 +/- 4.0 months follow-up. CONCLUSION: Targeting the largest atrial EGM in the isthmus can produce bidirectional block with a single site ablation. This supports the hypothesis that trans-isthmus conduction can occur over a discrete part of the isthmus, likely due to the underlying bundle architecture.
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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 | 0.001 |
| 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".