P366Radiofrequency catheter ablation technology to improve lesion formation
Bibliographic record
Abstract
Funding Acknowledgements: Centre of Heart Rhythm Disorder Introduction: Radiofrequency Catheter Ablation (RFCA) is the mainstay of invasive treatment of cardiac arrhythmias, particularly atrial fibrillation (AF). Despite the dramatic technological advances in RFCA, achievement of complete Pulmonary Vein Isolation (PVI) remains a challenge. Purpose: To systematically evaluate currentRFCA technology to provide therapeutic intervention and recommendations on the basis of the existing evidence. Methods: A systematic literature search, in English, was conducted on Ovid MEDLINE, Embase and PubMed with the keywords "radiofrequency catheter ablation*’, "contact-force*", "irrigated", "lesion formation" and "atrial fibrillation" up to 16 October 2017. Studies evaluating RFCA in lesion formation and factors influencing ablation outcome, such as power delivery, temperature, procedure time, impedance and radiation exposure were included. Clinical studies were evaluated for quality and risk of bias using the Cochrane Collaborations’ tool and/or Newcastle-Ottawa scale. Results: A total of 15 studies met our inclusion criteria, corresponding to 1,595 participants. We found two studies reporting on lesions, with one drawn from a randomised controlled, double-blind, trial and one from observational design. These demonstrated better lesions with contact force (CF)-guided circumferential PVI compared to non-guided ablation, and 8-mm tip and cooled-tip (40W) as compared to cooled-tip at 30W. Additionally, animal studies also revealed that the higher CF influences lesion depth, which is the key to lesion transmurality. Four studies reported CF-sensing vs non-CF catheters, mostly of observation cohorts and one RCT. Interestingly, CF catheters demonstrated a significant positive ablation outcomes compared to standard catheters, with almost 50% reduction in procedure and fluoroscopy times reported. Conclusions: The systematic review showed the evaluation of current available RFCA and the procedure outcome to assist in future catheter intervention. CF-sensing catheter demonstrated better ablation effectiveness and efficacy more than non-sensing catheters. However, despite the development of these novel catheters, AF recurrence remains high, which warrant newer techniques to ensure transmural lesions to achieve complete PVI. Abstract P366 Figure. RFCA data summary
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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 | 0.008 | 0.032 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.004 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.018 | 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".