Interpretation of discrete potential in idiopathic outflow tract ventricular arrhythmia: more consideration
Bibliographic record
Abstract
We read with interest the article by Liu et al.1 published recently in EP-Europace. In this article, the authors showed that discrete potentials (DPs) appeared to be a prerequisite for idiopathic outflow tract premature ventricular contractions (PVCs) and ventricular tachyarrhythmias (VTs), with DPs-guided mapping predictive of ablation success. A comparison of DPs with more well-established predictors of substrate mapping and ablation success, including local activation time, pace mapping, and unipolar mapping, is needed. However, the additional information gained from DPs-guided substrate mapping could guide radiofrequency ablation and increase success rates, especially in variable cases in which further optimization is needed. The source and significance of this DP has been debated in the literature, with the authors postulating DPs might represent a critical slow conduction zone or impaired connections between the ectopic pacemaker and normal right ventricular myocardium, rather than the arrhythmia focus itself. While this mechanism has been postulated previously, we interpret the DPs slightly differently. As Bloch Thomsen et al.2 noted, the pacemaker may be protected by entrance block, which ensures the pacemaker keeps its own rhythm and can drive PVCs or VT. We believe the high-frequency potentials represent a near-field potential generated by the ectopic pacemaker at the mapping site and a dull far-field potential in the surrounding tissues, which would precede the QRS complex as observed in the current study. As such, the presence of targeted DPs following successful ablation of the low-voltage region in the current study may suggest that the DPs are associated with the source rather than representing a slow conduction pathway. One way to detect whether DPs represent a slow conduction pathway is pacing. Pacing a slow conduction pathway will result in a prolongation between the stimulus and the onset of the QRS complex3 and pacing at the exit can get an equal interval of stimulus to QRS to local potential to QRS in arrhythmia,2 which would provide mechanistic support for the proposed mechanism of DPs. Therefore, we believe more information is needed to confirm the relationship between DPs and the origin of idiopathic outflow tract arrhythmias. Nevertheless, the findings of this study will be invaluable to cardiologists in the future and have inspired us to consider new approaches to the mapping of arrhythmias and the role of DPs in the mechanism of idiopathic outflow tract ventricular arrhythmias and related diseases.
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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 | 0.002 | 0.017 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.003 |
| Scholarly communication | 0.003 | 0.005 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.022 | 0.020 |
| Insufficient payload (model declined to judge) | 0.003 | 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".