Chronotropic incompetence in young patients with late postoperative atrial flutter: a case-control study
Bibliographic record
Abstract
AIMS: Atrial flutter causes late postoperative morbidity in congenital heart disease (CHD). Sinoatrial node dysfunction is associated with late postoperative atrial flutter, but pacing interventions driven by minimum heart rates (HR) have yielded mixed results. METHODS AND RESULTS: A retrospective case-control study was used to test the hypothesis that late postoperative atrial flutter is associated with chronotropic incompetence in active young CHD patients. Control CHD patients aged < or =18 years without documented supraventricular ectopy (n = 42) were matched with 42 patients (cases) having atrial flutter onset > or =6 months postoperatively. Minimum, average, and maximum non-flutter HRs were obtained from outpatient ambulatory 24 h ECG (Holter) recordings and graded exercise tests. Chronotropic competence was assessed using percentage of age-specific predicted maximum HR achieved, and calculated chronotropic index. Effects of rate-adaptive programming and maximum atrial pacing rates were analysed in 19 permanently paced cases. Least square estimates of minimum HRs were similar in cases and controls (54+/-2 vs. 52+/-2 bpm). Average HRs were lower in cases (75+/-2 vs. 81+/-2 bpm, P=0.02). Cases and controls differed most significantly with respect to percentage of predicted maximum HR achieved (67+/-2 vs. 80+/-2%, P < 0.001). This difference remained highly significant when the data were adjusted for age, sex, permanent pacing, and negatively chronotropic medication usage at the time of testing. Among paced patients, atrial flutter was significantly less likely to be observed in the setting of rate-adaptive pacing [odds ratio (OR) = 0.36; P < 0.05], and the likelihood of detecting atrial flutter decreased relative to the maximum programmed atrial pacing rate (OR 0.87 for every 5% increment in maximum pacing rate relative to maximum predicted HR for age; P < 0.05). CONCLUSION: Late postoperative atrial flutter is associated with chronotropic incompetence in paediatric CHD patients.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| 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".