VT storm in long QT resulting from COVID-19 vaccine allergy treated with epinephrine
Bibliographic record
Abstract
A 51-year-old lady with congenital prolonged QT syndrome, genotype unknown, with a baseline corrected QT interval (QTc) of ∼470 ms (Panel A), and a secondary prevention single chamber implantable cardioverter-defibrillator (ICD) (St. Jude Medical) in situ, presented to a community hospital with an anaphylactic reaction shortly after receiving her first dose of the Moderna COVID-19 vaccine. Her symptoms were refractory to multiple doses of epinephrine as well as solumedrol, Benadryl, and famotidine, necessitating an epinephrine infusion. Unfortunately, this caused further QT prolongation (Panel B), which precipitated recurrent polymorphic ventricular tachycardia (VT), with two successful antitachycardia pacing (ATP) terminations and one ICD shock. Panel C shows the initiation of the event in the device log with an R-on-T phenomenon triggering polymorphic VT. ATP was unsuccessful (Panel D) resulting in an ICD shock (Panel E), which restored sinus rhythm. Attempts to discontinue her epinephrine infusion were challenged by recurrent anaphylactic symptoms, predominantly hoarse voice, and throat tightening. She was transferred to a tertiary care centre where her device settings were changed to overdrive pace at a rate of 80 bpm (Panel F), shortening the QT interval and resulting in no further significant events or therapies while epinephrine was weaned. Although the allergen here could have been any agent, it is a useful reminder of the dangers of epinephrine in prolonged QT syndrome in the context of widespread vaccination. Although this lady was gene negative, this case is also informative for her future management since in this context she certainly behaved like an LQT1 patient. Funding: The authors report no specific funding related to this article. Conflict of interest: The authors have submitted their declaration which can be found in the article Supplementary Material online.
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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) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 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 | 0.001 |
| 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".