Short-Term Arrhythmia Prediction Using AI Based on Daily Data From Implantable Devices: Multicenter Prospective Observational Study.

Abstract

Background: Predictive medicine relies on algorithms to determine clinical treatments tailored to each patient's individual characteristics. Predictive models based on artificial intelligence have shown promise in identifying atrial fibrillation episodes; however, they rarely focus on short-term dynamic prediction.

Objective: This study aimed to evaluate the use of an artificial intelligence model and remote monitoring data extracted from pacemaker devices to predict the onset or worsening of arrhythmias in the short term.

Methods: This was a multicenter prospective observational study in which data from 314 patients were analyzed. A total of 65,243 data sequences were collected, of which 55,532 (85.1%) were used to train the algorithm. This model used 31-day records to predict whether the number of arrhythmic episodes would increase, decrease, or remain the same in the following 14 days.

Results: The sensitivity and specificity of the generated predictions were calculated from 9711 prediction-observation pairs. The global sensitivity was 66.4% (95% CI 64.3%-68.3%), and specificity was 77.4% (95% CI 76.4%-78.4%). For patients with baseline arrhythmia, sensitivity was 76.8% (95% CI 74.6%-78.8%), and specificity was 39.6% (95% CI 35.8%-43.5%). The prediction for patients with no baseline arrhythmia showed a sensitivity of 39% (95% CI 35.1%-43%) and a specificity of 81% (95% CI 80.0%-81.9%). The analysis for the patient subgroup without history of atrial fibrillation (232/314, 73.9%) yielded a 69% sensitivity (95% CI 66.5%-71.5%) and an 80% specificity (95% CI 79.3%-81.3%).

Conclusions: This model was capable of predicting short-term increases or decreases in arrhythmic episodes with reasonable sensitivity and specificity using data collected through remote monitoring of implantable devices. The model's performance is expected to improve progressively as more data samples become available, including demographic data and clinical records.