Use of Physiologic Pacing After the Canadian Trial of Physiologic Pacing
Bibliographic record
Abstract
The Canadian trial of physiologic pacing (CTOPP), published in 2000, demonstrated a reduction in atrial fibrillation (AF), stroke and death with preservation of atrioventricular synchrony, though only the lower rate of AF was statistically significant. The purpose of this study was to determine the effect of CTOPP on pacing mode selection in our region. The British Columbia Cardiac Registry contains prospectively entered data covering a population of 4 millions (M) and 17 implanting centers. It was examined for mode selection trends from 1997 to 2002. At examination, there were data on 22,446 pulse generators (PG) and 29,898 leads. New implant rates per M population were 1997:473; 1998:456; 1999:505; 2000:513; 2001:486; 2002:510. PG replacements also increased, resulting in a total implant rate of 667 PG per M in 2002. Over the 6-year period, DDD use decreased from 321 to 306, but DDDR use, more than doubled from 317 to 750 PG/year. VVI use steadily decreased from 741 to 410 PG/year, while VVIR use increased more modestly from 1997 to 1999, then remained stable. During the 6-year period bracketing CTOPP, use of modes maintaining AV synchrony increased by over 32%, to 53% of PG implanted in 2002. Our PG implant rate was much higher than expected from prior retrospective surveys, and similar to rates in Belgium, France, and Germany. CTOPP did not decrease our use of physiologic pacing but, instead, was associated with a brief pause, then progressively increased in both academic and community centers. Patients' need and widely accepted standards of care proved more important in clinical decision making than the results of a flawed randomized trial.
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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 | 0.003 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".