Successful Implant of a Subcutaneous ICD System in a Patient with an Ipsilateral Epicardial Pacemaker
Bibliographic record
Abstract
A 25 year old female with a history of intravenous drug abuse developed Staph Aureus endocarditis and required mitral and tricuspid valve replacement with tissue bioprostheses.Her recovery was complicated by new, severe aortic regurgitation requiring a bioprosthetic aortic valve replacement several days later.She was noted to be in third degree AV block during the second operation and a permanent bipolar epicardial pacing lead was placed intra-operatively on the right ventricle.Subsequently this lead was tunneled subcutaneously from the epigastrium to the left pre-pectoral position and attached to a single-chamber pacemaker pulse generator.Whilst convalescing on the ward the patient suffered two cardiac arrests due to polymorphic VT despite consistent pacing at 50 bpm.There was no evidence of QT prolongation or coronary artery disease and therefore overdrive pacing was not originally indicated.Moreover, her left ventricular systolic function was also within normal limits.However; the treating team felt that given the patient's valve disease and two cardiac surgical procedures, that there had to be a substrate for recurrent arrhythmia, presumably small areas of myocardial scar.In addition to increasing the lower pacing rate to 90 bpm, the decision was taken to implant a subcutaneous ICD (S-ICD system, Boston Scientific/Cameron Health).An S-ICD was selected due to the risk of further infection with a transvenous ICD; however we were concerned about possible device-device interaction.We had also considered connecting the epicardial pacing lead to a standard ICD and adding a subcutaneous array but we felt the S-
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| 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) | 0.000 | 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 teacher head, 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".