Abstract 17036: Transesophageal Electrophysiology Study as a Tool to Guide Post-natal Management of Fetal Supraventricular Tachycardia
Bibliographic record
Abstract
Background: With advancements in fetal echocardiography, the diagnosis of supraventricular tachycardia (SVT) is now often made antenatally. There is wide variability in the post-natal management and indications to initiate therapy have not been clearly defined. Esophageal recording and pacing is a useful and minimally invasive tool in the assessment and management of SVT. The proximity of the esophagus to the atria in an anatomically normal individual allows for excellent atrial signal recording as well as noninvasive-programmed stimulation to elicit or terminate reentrant SVT. Transesophageal-pacing study (TEPS) has been used to predict clinical recurrence and efficacy of various management strategies in patients with neonatal SVT, but was never used as a tool to guide post-natal management in newborns with a pre-natal diagnosis of SVT. Hypothesis: Our primary hypothesis is that TEPS can guide post-natal management in patients with fetal SVT. Secondary objectives were to evaluate if fetal echo accurately diagnoses SVT mechanism and to assess the proportion of fetal SVT that will resolve by the time of birth. Methods: A retrospective review of all cases of fetal SVT at the Hospital for Sick Children of Toronto from 1999 to 2015 was performed. Results: A total of 66 patients were included. There were 6 intra-uterine demises. Of the liveborns, 41% had spontaneous SVT during the observation period. Of the 59% remaining, half had inducible SVT during the TEPS. Overall, 70% of patients with a fetal diagnosis of SVT had post-natal recurrence, either spontaneous or inducible. None of the “non-inducible patients” had long-term recurrence. Conclusions: TEPS is a valid tool to evaluate the need for postnatal therapy in fetal SVT. Based on the results, treatment could be safely avoided in approximately a third of the patients. Futures studies should be done to evaluate long-term spontaneous recurrence of SVT in inducible patients without initiation of treatment.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 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".