Let’s get down to the nitty-gritty in persistent atrial fibrillation: the continuous critical mass of the atria—Authors’ reply
Bibliographic record
Abstract
We would like to thank the author for making this excellent point regarding the possible mechanistic implications of our study.1 While we did find that linear ablation, posterior wall isolation (PWI), and complex fractionated atrial electrogram (CFAE) ablation was associated with increased intraprocedural atrial fibrillation (AF) termination, importantly only PWI and left atrial appendage (LAA) isolation was associated with improved freedom from AF. Intraprocedural AF termination was not associated with improved long-term freedom from AF.2 The fact that PWI and LAA isolation were additive to PVI in success is certainly consistent with the critical mass hypothesis. We agree this could explain the findings of our study. Pulmonary vein sleeves can be quite long3 and so PVI itself may be a significant contributing factor to atrial debulking and this may explain part of the success of this procedure. On the other hand, we must balance the extent of atrial debulking, this can be taken to an extreme and we must be cautious to maintain mechanical function. There is some data on surgical maze suggesting preservation of mechanical function is associated with persisting success.4 Increased left atrial ablation, particularly in the form of CFAE ablation, increases recurrences due to atrial tachycardias,5 although this does not necessarily contradict the critical mass hypothesis for AF. With these provisos however, with recent evidence showing that our attempts to target specific subtle variations in the substrate (e.g. rotors) do not add to the success of standard PVI, we would broadly agree with Dr Garcia-Villarreal. While reduction of critical mass is certainly not the whole story, it is a very good beginning. Time will tell where the next chapter takes us. Conflict of interest: none declared.
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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 | 0.006 | 0.042 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.005 |
| Scholarly communication | 0.003 | 0.008 |
| Open science | 0.004 | 0.002 |
| Research integrity | 0.038 | 0.055 |
| Insufficient payload (model declined to judge) | 0.004 | 0.004 |
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".