Reduction of QRS duration following pulmonary valve replacement in tetralogy of Fallot: implications for arrhythmia reduction?
Bibliographic record
Abstract
This editorial refers to ‘Reduction of QRS duration after pulmonary valve replacement in adult Fallot patients is related to reduction of right ventricular volume’† by B. Hooft van Huysduynen et al., on page 928 Tetralogy of Fallot is the commonest form of cyanotic congenital heart disease, and early outcomes following surgical repair are steadily improving. Nonetheless, these patients remain at risk for late-onset arrhythmias as well as sudden death.1,2 Increased QRS duration and right ventricular (RV) dilation secondary to pulmonary regurgitation have both been described as markers for increased risk of ventricular arrhythmias and sudden death.3–5 Pulmonary valve replacement (PVR) in these patients has been shown to stabilize the QRS duration and, when combined with cryoablation, to decrease the incidence of ventricular arrhythmias.6 Hooft van Huysduyen et al.7 present a retrospective series of adult patients with tetralogy of Fallot, who were assessed before and after PVR with both electrocardiograms (ECG) and cardiac magnetic resonance imaging. In their series, patients demonstrated a significant decrease in both RV end-diastolic volume and QRS duration, with reasonable correlation between these two values. This is the first paper to demonstrate a decrease in QRS duration, rather than simply stabilization. Interestingly, not all patients showed a reduction in QRS duration, but there was a non-significant trend toward greater reduction in RV volumes in those patients with a decrease in QRS duration. QRS duration measurement was performed using averaged beats rather than the more standard technique of using maximal QRS length in any lead on a standard ECG. Although this may have influenced absolute values of QRS, it is unlikely to have biased the results, as it is the change from pre-operative to post-operative rather than the absolute value of the QRS that was considered.
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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 | 0.001 | 0.013 |
| 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 | 0.000 |
| Research integrity | 0.012 | 0.006 |
| Insufficient payload (model declined to judge) | 0.003 | 0.002 |
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".