A Retrograde Transaortic/Transmitral Approach for Radiofrequency Ablation of Adenosine-Sensitive Atrial Tachycardia Arising Near the Apex of Koch’s Triangle: A Case Study Approach and Review of the Literature
Bibliographic record
Abstract
Atrial tachycardias (ATs) are relatively uncommon and their mechanisms include reentry or may be focal. The characteristics and radiofrequency (RF) ablation of adenosine-sensitive AT arising near the apex of Koch's triangle have been reported. We report a case of successful RF ablation of this tachycardia by using a retrograde transaortic/transmitral approach. An electrophysiological study performed during sinus rhythm showed continuous anterograde atrioventricular nodal and no ventriculoatrial conduction. The tachycardia could be induced and terminated by atrial extrastimulation and rapid atrial pacing. Although inverse resetting response pattern was observed, tachycardia termination by intravenous low-dose adenosine was rather suggestive of triggered activity as the mechanism. The earliest atrial activation was recorded in the His-bundle region. After ineffective right-sided attempts and failure to find earlier atrial activity during mapping the noncoronary sinus of Valsalva, this tachycardia was successfully ablated from the left atrial septum by using a retrograde transaortic/transmitral approach. This report demonstrates the feasibility of a novel retrograde left atrial approach for RF ablation of adenosine-sensitive AT originating from the apex of Koch's triangle.
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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) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".