Ganglionated plexi ablation during cryoballoon ablation prevents recurrence of atrial fibrillation
Bibliographic record
Abstract
Purpose: Ablation of ganglionic plexi (GP) manifested by overt vagal reaction during the ablation procedure has been reported as an important determinant of procedural success in patients with atrial fibrillation (AF). In this study, we aimed to investigate whether vagal reactions during cryobaloon ablation of AF as a sign of GP modification is associated with recurrence of AF. Methods: We enrolled a total of 145 patients with a mean age of 54.50±10.15 years and 76 of the patients were male (52.4%). A 28-mm cryoballoon catheter (Arctic Front©, Medtronic CryoCath LP, Kirkland, Canada) was used for pulmonary vein isolation. A minimum of two consecutive freezing cycles for each targeted PV were delivered with excellent or good occlusion. Vagal reaction was defined as sinus bradycardia (<40 bpm), asystole, AV block, or hypotension that occurred within a few seconds of the onset of RF application which resumed immediately after IV atropin administration. Results: Acute procedural success was 96.2% and procedural time was 74.4±6.2 minutes. Recurrence of AF was observed only in 26 (17.9%) patients. Vagal reaction and necesity for atropin were more common in patients without recurrence (46.2% vs. 15.4%, p= 0.004 and %38.7 vs. 7.7%, p= 0.002, respectively). Multivariate analysis revealed that non-paroxysmal AF (HR; 1.74; CI: 1.28-2.92, p=0.002), left atrial diameter (HR; 1.17; CI: 1.09-1.27, p=0.001), unnecessity for atropin administration (HR; 0.064; CI: 0.008-0.48, p=0.008) and early recurrence (HR; 3.12; CI: 2.26-5.66, p=0.001) significantly increased AF recurrence. Conclusion: Our findings indicate for the first time that the occurence of vagal reaction during cryoballoon for AF ablation decreases the rate of recurrences in the follow up. Cryoballoon ablation might benefit by decreasing AF recurrence by the modification of GP in addition to pulmonary vein isolation.
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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 | 0.000 | 0.001 |
| 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) | 0.001 | 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 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".