Electrical organization of torsades de pointes into monomorphic ventricular tachycardia
Bibliographic record
Abstract
A 55-year-old male with a history of atrial fibrillation and atrioventricular node ablation with permanent pacemaker implantation, presented with atypical chest pain and a positive troponin I (1.15 μg/L; normal range: 0.00–0.04 μg/L). His admission electrocardiogram (ECG) demonstrated a ventricularly paced rhythm with underlying atrial fibrillation (Supplementary material online, Image S1). His home medications included: bisoprolol 5 mg daily, furosemide 40 mg daily, amitriptyline 150 mg daily, zopiclone 15 mg daily, pantoprazole 40 mg daily, and long-acting oxycodone 60 mg three times a day. On presentation, he was treated as a non-ST-segment elevation myocardial infarction; however, coronary angiography demonstrated non-obstructive coronary disease (Supplementary material online, Videos S1 and S2). His echocardiogram demonstrated reduced (35%) left ventricular ejection fraction (Supplementary material online, Videos S3 and S4). Overnight, the patient became increasingly agitated and received a dose of 5 mg of haloperidol. He subsequently had an ECG that demonstrated a paced rhythm at 70 b.p.m. and a QTc of 648 ms (Panel A). Shortly afterwards, he experienced a torsades de pointes polymorphic ventricular tachycardia (VT) arrest (Panel B) that organized into a regular monomorphic VT (Panel C). He was electrically defibrillated and returned to a paced rhythm. A cardiac magnetic resonance imaging study demonstrated diffuse increase in T2 signal (Panel D) and non-ischaemic enhancement of the inferior wall and inferolateral wall compatible with myocarditis (Panel E). He underwent an implantable cardioverter-defibrillator implantation and was discharged uneventfully. The patient’s use of amitriptyline, pantoprazole, and in-hospital administration of haloperidol likely precipitated his long QT and subsequent torsades de pointes. While early afterdepolarization and triggered activity commonly induce torsades de pointes, this rhythm is generally non-sustained or degenerates into ventricular fibrillation. However, in our case, the rhythm organized into a regular monomorphic VT suggestive of underlying myocardial substrate (in this case myocarditis) that resulted in a re-entrant circuit. While extremely rare, in cases of organizing polymorphic VT, investigations to assess for a focal myocardial arrhythmia substrate may be warranted. Supplementary material is available at European Heart Journal - Case Reports online. Consent: The authors confirm that written consent for submission and publication of this case report including image(s) and associated text has been obtained from the patient in line with COPE guidance.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| 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 | 0.000 | 0.000 |
| 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".