LAUSR

Artificial intelligence (AI) using electrocardiogram (ECG) enabled to predict atrial fibrillation (AF) in patients without documented AF. Mobile single-lead ECG is more convenient to surveil cardiac rhythm with simple measurement. However, AI-enabled arrhythmia predictability by mobile ECG is limited due to single channel utilization and longer duration for arrhythmia diagnosis. We aimed to enhance mobile single-lead ECG AF prediction AI algorithm integrated with 12-lead ECG using deep learning model. Based on 552,372 12-lead ECG data of 318,321 patients, a statistical AF prediction model employing a deep-learning approach was constituted. Out of single-lead 13,509 ECGs from a total of 6,719 patients, we utilized a total of 10,287 normal sinus rhythm ECGs from 5,170 patients. Resnet structure was utilized to distinguish subtle changes of the vicinity of P-wave. Single-lead mobile ECGs were adjusted with noise filtering and segmented every 10 seconds. A random under-sampling was applied to reduce bias from data imbalance. Both 12-lead ECG and single-lead ECG were allocated to training, validation, testing datasets in a 6:2:2 ratio. Then, we conducted transfer learning using the standard 12-lead ECG’s deep learning model to improve performance of single-lead mobile ECG deep learning model. AF was annotated in 26,541 (4.8%) with 12-lead ECG whereas 1,443 (21.2%) with single-lead mobile ECG. The area under the curve (AUC) value for predicting AF was 0.910 with 12-lead ECG, and 0.742 with mobile ECG. The predictive performance of mobile ECG was 67.5% in accuracy, 64.2% in sensitivity and 66.8% in F1-score. The AUC value of mobile ECG after applying transfer learning based on 12-lead ECG for AF prediction was increased to 0.790 with accuracy of 73.8%, sensitivity of 65.5% and F1-score of 71.0%. Integration with deep learning algorithm of standard 12-lead ECG significantly improved the model performance of single-lead ECG AF prediction model compared to single-lead mobile ECG only based model. Easy application of mobile ECG with enhanced AF predictability might serve a more convenient method as a pre-emptive assistive tool to provide probabilistic prediction for PAF screening rather than 12-lead ECG.