Automatic screening of patients with atrial fibrillation from 24-h Holter recording using deep learning

Abstract

Aims

As the demand for atrial fibrillation (AF) screening increases, clinicians spend a significant amount of time identifying AF signals from massive amounts of data obtained during long-term dynamic electrocardiogram (ECG) monitoring. The identification of AF signals is subjective and depends on the experience of clinicians. However, experienced cardiologists are scarce. This study aimed to apply a deep learning-based algorithm to fully automate primary screening of patients with AF using 24-h Holter monitoring.

Methods and results

A deep learning model was developed to automatically detect AF episodes using RR intervals and was trained and evaluated on 23 621 (2297 AF and 21 324 non-AF) 24-h Holter recordings from 23 452 patients. Based on the AF episode detection results, patients with AF were automatically identified using the criterion of at least one AF episode lasting 6 min or longer. Performance was assessed on an independent real-world hospital-scenario test set (19 227 recordings) and a community-scenario test set (1299 recordings). For the two test sets, the model obtained high performance for the identification of patients with AF (sensitivity: 0.995 and 1.000; specificity: 0.985 and 0.997, respectively). Moreover, it obtained good and consistent performance (sensitivity: 1.000; specificity: 0.972) for an external public data set.

Conclusion

Using the criterion of at least one AF episode of 6 min or longer, the deep learning model can fully automatically screen patients for AF with high accuracy from long-term Holter monitoring data. This method may serve as a powerful and cost-effective tool for primary screening for AF.

Graphical Abstract

Graphical Abstract

A deep learning algorithm uses RR interval data to automatically detect AF episodes and identify patients with AF. AF, atrial fibrillation; PAF, paroxysmal AF; WAF, whole-course AF; NAF, non-AF; AUC, area under the ROC curve; CI, confidence interval.