Development of an Artificial Intelligence-Enabled Electrocardiography to Detect 23 Cardiac Arrhythmias and Predict Cardiovascular Outcomes.

Abstract

Arrhythmias are common and can affect individuals with or without structural heart disease. Deep learning models (DLMs) have shown the ability to recognize arrhythmias using 12-lead electrocardiograms (ECGs). However, the limited types of arrhythmias and dataset robustness have hindered widespread adoption. This study aimed to develop a DLM capable of detecting various arrhythmias across diverse datasets. This algorithm development study utilized 22,130 ECGs, divided into development, tuning, validation, and competition sets. External validation was conducted on three open datasets (CODE-test, PTB-XL, CPSC2018) comprising 32,495 ECGs. The study also assessed the long-term risks of new-onset atrial fibrillation (AF), heart failure (HF), and mortality in individuals with false-positive AF detection by the DLM. In the validation set, the DLM achieved area under the receiver operating characteristic curve above 0.97 and sensitivity/specificity exceeding 90% across most arrhythmia classes. It demonstrated cardiologist-level performance, ranking first in balanced accuracy in a human-machine competition. External validation confirmed comparable performance. Individuals with false-positive AF detection had a significantly higher risk of new-onset AF (hazard ration [HR]: 1.69, 95% confidence interval [CI]: 1.11-2.59), HF (HR: 1.73, 95% CI: 1.20-2.51), and mortality (HR: 1.40, 95% CI: 1.02-1.92) compared to true-negative individuals after adjusting for age and sex. We developed an accurate DLM capable of detecting 23 cardiac arrhythmias across multiple datasets. This DLM serves as a valuable screening tool to aid physicians in identifying high-risk patients, with potential implications for early intervention and risk stratification.