Extensive atrial fibrosis assessed by late gadolinium enhancement cardiovascular magnetic resonance associated with advanced interatrial block electrocardiogram pattern
Bibliographic record
Abstract
The electrocardiogram (ECG)-based criteria of partial and advanced interatrial block (P-IAB, P ≥ 120 ms; A-IAB, P ≥ 120 ms plus biphasic (±) morphology in the inferior leads) and their association with atrial fibrillation/flutter were described by Bayés de Luna et al. in the 1980s. We present the case of an 82-year-old man. Over the years, his ECG pattern has developed from normal P wave to P-IAB and later A-IAB (Panel A) and presents short AF runs during Holter monitoring. Panel A shows that the clear A-IAB pattern with a very low voltage identifies a clear P wave with the biphasic (±) morphology. We obtained a 3D reconstruction of 3T late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) (Panel B) showing extensive biatrial fibrosis with clear involvement of the upper part of the septum (Bachmann's bundle; arrows). The image intensity ratio between CMR local signal intensity of LGE and mean signal intensity of blood pool depicts the degree of fibrosis in a colour scale (dense fibrosis in red). The image describes the association between A-IAB and atrial fibrosis in both atria detected by LGE-CMR, explaining the abnormal atrial activation. Overall, this sequence demonstrates non-invasively that atrial fibrosis is a key factor in explaining the ECG pattern of A-IAB. The full-length version of this report can be viewed at: http://www.escardio.org/Guidelines-&-Education/E-learning/Clinical-cases/Electrophysiology/EP-Case-Reports.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".