17 The use of half concentration saline is superior for the catheter ablation of typical atrial flutter
Bibliographic record
Abstract
Background Radiofrequency ablation for typical atrial flutter (AFL) is widely performed. The effectiveness of catheter ablation for AFL is typically confirmed via complete bidirectional block (BB) of the cavotricuspid isthmus (CTI). Standard irrigated radiofrequency ablation is performed using normal saline (NS, 0.9%), yet previous evidence suggests that wider and deeper lesions may be achieved by decreasing the irrigant ionic concentration with half normal saline (HNS, 0.45%). Therefore, it has yet to be determined whether HNS may alter lesion characterization in human subjects and lead to improve outcomes post-ablation. Objective The purpose of this study was to compare the use of HNS to NS for catheter ablation of typical AFL with respect to the time taken to achieve BB, radiofrequency time, and recurrence of conduction within 30 minutes. The incidence of intraoperative complications, including steam pops and pericardial effusions, was also recorded. Methods Patients were randomized to catheter ablation with either NS or HNS using a 4 mm irrigated catheter at a power setting of 30W. Ablation was performed with the aim of restoring sinus rhythm in patients who were in AFL. BB was confirmed by double potentials separated by an isoelectric line measuring ≥ 110 ms and evidence of conduction block using differential pacing. Results A total of 30 patients underwent catheter ablation for typical AFL (14 HNS, 16 NS). Sinus rhythm and bidirectional block were achieved in all patients. The two groups did not differ with respect to patient age (69±10 years HNS vs. 71±15 years NS) or duration of AFL (7±6 months HNS vs. 8±5 months NS). The mean time to achieve BB using RF was 10.4±2.6 mins using HNS compared with 14.5±3.8 mins using NS (p=0.01). There was a higher incidence of steam pops amongst patients in the HNS arm (2 HNS vs. 0 NS). Conversely, recurrences of conduction were higher for patients in the NS group as compared to HNS, 3 vs. 0 respectively. Conclusion By decreasing ionic concentration in radiofrequency ablation using HNS, the time taken to achieve BB was shorter as compared to NS. There were no major complications observed in either group, but patients undergoing catheter ablation with NS experienced an increased frequency of recurrences of conduction within 30 minutes.
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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 | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| 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".