Electrocautery-induced ventricular fibrillation during routine implantable cardioverter-defibrillator generator replacement
Bibliographic record
Abstract
A 78-year-old man with a primary-prevention implantable cardioverter-defibrillator (ICD) underwent an elective generator replacement. The pre-procedural lead parameters were normal and tachycardia detection was turned off during the procedure. During a 4.6 s application of unipolar electrocautery to the pocket, transient contact was made with the device generator and the patient developed ventricular fibrillation. The cautery pen had not contacted the lead, which had no obvious insulation breach. Transthoracic cardioversion was delivered and successfully restored sinus rhythm. The patient suffered no long-term harm. Although electrocautery is frequently used in device surgery and accidental contact with the ICD generator is common, the induction of ventricular arrhythmias is extremely rare. It has been previously reported with bipolar electrocautery at a low-power setting, but this case involved unipolar cautery. In Medtronic ICDs, the pulse generator internal circuitry is electrically isolated from the leads by a field effect transistor (FET). However, in situations where the FET is overloaded or bypassed such as with externalized conductor wires or insulation breach, there is a risk of transmitting cautery energy down the leads and inducing ventricular fibrillation. Care should be employed when using electrocautery near an implanted device. The full-length version of this report can be viewed at: http://www.escardio.org/communities/EHRA/publications/ep-case-reports/Documents/electrocautery-induced-ventricular-fibrillation.pdf.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
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".