Bibliographic record
Abstract
We are honored by Professor Belhassen’s interest in our report1Maxwell N. Dryer M.M. Baranchuk A. Vinocur J.M. Phase 4 block of the right bundle branch suggesting His-Purkinje system involvement in Lyme carditis.HeartRhythm Case Rep. 2020; 7: 112-116Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar of Lyme carditis manifesting with high-grade atrioventricular block and intermittent late-coupled beats of right bundle branch–like morphology. We proposed that these beats were conducted with aberrancy owing to phase 4 block in the right bundle. In retrospect, perhaps we should have set out several alternatives, for as Professor Mauricio Rosenbaum used to say, “Every complex arrhythmia has at least 3 different explanations!”2Wellens H.J. Reply to the Editor - high-degree atrioventricular block in a 77-year-old man.Heart Rhythm. 2017; 14: e271Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar,3Varriale P. Gul E.E. Ali F.S. Glover B. Baranchuk A. More about grouped beating: What's the diagnosis? The “Rosenbaum's approach to ECG diagnosis.J Electrocardiol. 2016; 49: 749-751Crossref Google Scholar Professor Belhassen hypothesizes instead that these beats are from a ventricular escape rhythm. We acknowledge the merits of this explanation, and appreciate particularly his astute observation of a very subtle fusion beat (third beat in Figure 2C). Additionally, we observe the wide beats lack typical right bundle branch block pattern as might be expected with a discrete proximal injury in an otherwise normal heart. With regard to the observation that there is no other disturbance of His-Purkinje conduction, we note the right axis deviation seen on narrow-complex beats at presentation and throughout the acute period, but absent at outpatient follow-up (not shown). This may represent transient left posterior fascicular block4Pérez-Riera A.R. Barbosa-Barros R. Daminello-Raimundo R. de Abreu L.C. Tonussi Mendes J.E. Nikusc K. Left posterior fascicular block, state-of-the-art review: A 2018 update.Indian Pacing Electrophysiol J. 2018; 18: 217-230Crossref PubMed Scopus (7) Google Scholar (seen best in Figure 3B; precordial lead placement may have been imperfect in Figure 2 owing to external pacing pads). We lack provocative maneuvers or intracardiac recordings to provide definitive resolution to this question. However, in either case, there is reason to question the integrity of the His-Purkinje system; as Professor Belhassen notes, an adolescent with atrioventricular nodal block should have a junctional escape. To the Editor—Phase-4 RBBB in Lyme carditis?HeartRhythm Case ReportsVol. 7Issue 7PreviewMaxwell and colleagues1 recently reported the case of an adolescent with Lyme carditis who exhibited high-degree atrioventricular (AV) block and “phase-4 right bundle branch block (RBBB).” Full-Text PDF Open Access
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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 | 0.003 | 0.040 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.003 |
| Scholarly communication | 0.002 | 0.006 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.030 | 0.030 |
| Insufficient payload (model declined to judge) | 0.008 | 0.006 |
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".