Atrial fibrillation and stroke after atrial septal defect closure. Is earlier closure warranted?
Bibliographic record
Abstract
Atrial septal defects (ASDs) are the most common congenital cardiac abnormalities in adults. Patients frequently present with symptoms for the first time at adult age. One of the most common late complications of an ASD is the development of atrial tachyarrhythmias (ATs), especially atrial fibrillation (AF). In a large population-based study from Ontario, the prevalence of AT was 19% in adult patients with ASD, which is fourfold higher than that in the general population.1 The incidence of AT continues to increase with age.2 ,3 This vulnerability to AT is not surprising considering the long-standing haemodynamic derangements due to left-to-right shunting causing atrial stretch, RV dilatation, elevated pulmonary arterial pressure and atrioventricular valve regurgitation. The resultant atrial electrical remodelling with increased dispersion of atrial refractoriness may predispose to AT. Furthermore, in surgically corrected patients, the presence of patches and suture lines may create the substrate for macroreentry AT. The current guidelines recommend closure of an ASD when there are signs of RV volume overload (in the absence of pulmonary hypertension) or if there is a suspicion of paradoxical embolism. In earlier studies, the prevalence of prior AT at the time of surgical closure at adult age is approximately 20%.2 ,3 ASD closure is associated with reduction in right atrial and ventricular volume and an increase in RVEF. However, atrial electrical and structural remodelling …
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.005 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".