Characterizing fast pathway in typical and atypical atrioventricular nodal re-entrant tachycardia by atrial-His and His-atrial: more to consider
Bibliographic record
Abstract
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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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 | 0.014 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| 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 | 0.001 | 0.001 |
| Research integrity | 0.013 | 0.011 |
| Insufficient payload (model declined to judge) | 0.002 | 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".