Resumption of dormant accessory pathway conduction with adenosine administration: a simple intervention to ensure successful accessory pathway ablation
Bibliographic record
Abstract
A 19-year-old with supraventricular tachycardia was referred for an electrophysiology study. Delta waves were absent and the HV interval 36 ms. Orthodromic atrioventricular reentrant tachycardia utilizing a left-septal accessory pathway (AP) was diagnosed and radiofrequency energy delivered at the site of earliest retrograde atrial activity during ventricular pacing. Loss of ventriculoatrial (VA) conduction occurred during ablation. Approximately 30 min post-ablation, administration of intravenous adenosine during ventricular pacing resulted in transient resumption of VA conduction (Panels A and B). As VA conduction was absent at various pacing rates and adenosine inhibits atrioventricular (AV) nodal conduction, our findings were consistent with transient retrograde AP conduction. Since VA conduction block persisted thereafter and for a total of 1 h post-ablation, the procedure was terminated. Unfortunately, there was recurrence of the index arrhythmia. This case highlights the utility of adenosine in unmasking dormant retrograde AP conduction post-ablation. Adenosine's effect in this case was not mediated by its effect on the AV node given the presence of VA conduction block prior to its administration. Rather, adenosine likely facilitated hyper-polarization of injured but still viable tissue at the AP atrial insertion site. Intra-procedural administration of adenosine may be valuable in identifying injured cardiac tissue, which may recover thereby resulting in future arrhythmia recurrence. The full-length version of this report can be viewed at: http://www.escardio.org/communities/EHRA/publications/ep-case-reports/Documents/Resumption-of-dormant-accessory-pathway.pdf.
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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) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
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".