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Record W4414629805 · doi:10.58931/cct.2025.1210

Physiologic Pacing in 2025: Guidance Made Simple

2025· article· en· W4414629805 on OpenAlexaff
Corrado De Marco

Bibliographic record

VenueCanadian Cardiology Today · 2025
Typearticle
Languageen
FieldMedicine
TopicCardiac pacing and defibrillation studies
Canadian institutionsCentre Hospitalier de l’Université de Montréal
Fundersnot available
KeywordsCardiac resynchronization therapyQRS complexHeart failureEjection fractionLeft bundle branch blockVentricular pacingAdverse effectBundle branch blockConfidence interval

Abstract

fetched live from OpenAlex

Conventional right ventricular pacing (RVP), particularly at the right ventricular apex, has long been the standard approach for ventricular pacing in patients requiring permanent pacemakers. However, RVP has been shown to introduce electrical and mechanical dyssynchrony, resulting in adverse remodelling, atrial fibrillation, and heart failure. The deleterious effects of a high RVP burden have been demonstrated in the MOST and DAVID trials, wherein patients with ventricular pacing >40% were identified as being at risk of increased adverse clinical outcomes, such as hospitalization for heart failure and death (hazard ratio [HR] 1.61; 95% confidence interval [CI] 1.06–2.44). In patients with baseline ventricular systolic dysfunction and left bundle branch block or a high ventricular pacing burden, cardiac resynchronization therapy (CRT) using conventional biventricular pacing (BiVP) has been shown to be superior to RVP in preventing ventricular dilation, hospitalization for heart failure, and death. Both the BLOCK-HF trial, which compared BiVP to RV pacing in patients with a left ventricular ejection fraction (LVEF) ≤50% and a high pacing burden, and the MADIT-CRT trial, which compared implantable cardioverter-defibrillator therapy alone to CRT with defibrillator in patients with LVEF ≤30% and QRS duration ≥130ms, showed a reduction in all-cause mortality and heart failure events in the BiVP group (HR 0.74; 95% CI 0.60–0.90 and HR 0.66; 95% CI 0.52–0.84, respectively). However, approximately one-third of patients do not respond to conventional BiVP. Moreover, the benefits of conventional BiVP have not been consistently shown across all cohorts. To overcome the detrimental effects of RVP and the limitations of conventional BiVP, conduction system pacing (CSP) was introduced. This approach harnesses the His-Purkinje system, thereby delivering stimulation mimicking native ventricular activation. The two primary CSP techniques, His bundle pacing (HBP) and left bundle branch area pacing (LBBAP), have demonstrated promise in improving both electrical synchrony and clinical outcomes.

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 imitation

Not 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.

metaresearch head score (Codex)0.000
metaresearch head score (Gemma)0.000
Version: codex-gemma-dda1882f352aValidation status: machine_predicted_unvalidated
Candidate categoriesnone
Consensus categoriesnone
DomainCandidate signal: none · Consensus signal: none
Study designCandidate signal: Observational · Consensus signal: Observational
GenreCandidate signal: Empirical · Consensus signal: none
Teacher disagreement score0.626
Threshold uncertainty score0.996

Codex and Gemma teacher scores by category

CategoryCodexGemma
Metaresearch0.0000.000
Meta-epidemiology (narrow)0.0000.000
Meta-epidemiology (broad)0.0010.000
Bibliometrics0.0000.000
Science and technology studies0.0000.000
Scholarly communication0.0000.000
Open science0.0000.000
Research integrity0.0000.000
Insufficient payload (model declined to judge)0.0000.000

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.

Opus teacher head0.019
GPT teacher head0.296
Teacher spread0.277 · how far apart the two teachers sit on this one work
Validation statusscore_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it

Classification

machine, unvalidated

Machine predicted; a candidate call from one teacher head, not a consensus.

The models applied no category: nothing in the taxonomy fit this work.
Study designObservational
Domainnot available
GenreEmpirical

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".

Quick stats

Citations0
Published2025
Admission routes1
Has abstractyes

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