Ibutilide Pretreatment to Facilitate Cardioversion of Refractory Atrial Fibrillation in a Patient with Morbid Obesity
Bibliographic record
Abstract
INTRODUCTION Electrical cardioversion is an effective means for converting atrial fibrillation to normal sinus rhythm, with conversion rates ranging from 70% to 90%.1 There are a number of treatment alternatives for patients with atrial fibrillation that is refractory to conventional monophasic electrical cardioversion, including external biphasic shock, pretreatment with antiarrhythmic medication, high-energy monophasic shocks, and internal cardioversion. External biphasic shock is becoming the standard of care in the electrical cardioversion of atrial fibrillation.2 However, even with this modality, atrial fibrillation is resistant to cardioversion in a small proportion of patients. In this setting, use of antiarrhythmic (class III) medication to facilitate cardioversion may be an attractive approach.1 This report describes the use of ibutilide for atrial fibrillation refractory to cardioversion with both amiodarone and biphasic shock. This case is also important because of the role that obesity played in the patient’s recurrent/resistant atrial fibrillation and in the pharmacokinetics of antiarrhythmic agents.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.002 | 0.002 |
| 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".