Simple and non-invasive diagnostics of a broad complex tachycardia in a device patient
Bibliographic record
Abstract
A 36-year-old woman presented with paroxysmal palpitations and shortness of breath to the emergency department. She was known to have transposition of the great arteries and had undergone the Mustard operation, in addition to having a pacemaker implanted. The electrocardiogram at the time of admission showed a broad QRS complex tachycardia with a ventriculoatrial time of ∼100 ms. Panel A shows the response to atrial overdrive pacing. After cessation of pacing (*), the last entrained ventricular (V) is demonstrated by the arrows, and is one beat removed, i.e. the PR interval was far greater than the RR, indicating the existence of dual-atrioventricular (AV) nodal physiology, due to the paced AV delay being substantially longer than the RR interval. In addition, an A–V–A response is seen ruling out ventricular tachycardia or junctional tachycardia. Finally, entrainment of the tachycardia (Panel B) with ventricular pacing has a V–A–V response upon cessation of pacing, which again suggests atrioventricular nodal reentrant tachycardia (AVNRT) or atrioventricular reentrant tachycardia. The long post-pacing interval minus the tachycardia cycle length (180 ms) supports the diagnosis of AVNRT. Patients with cardiac pacing devices who present with tachycardia offer an opportunity to conduct basic bedside electrophysiological studies that can provide exact diagnoses and allow treatment via the pacemaker. The full-length version of this report can be viewed at: http://www.escardio.org/communities/EHRA/publications/ep-case-reports/Documents/-broad-complex-tachycardia.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 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 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".