Near-term prediction of sustained ventricular arrhythmias applying artificial intelligence to single-lead ambulatory electrocardiogram

Abstract

BACKGROUND AND AIMS: Accurate near-term prediction of life-threatening ventricular arrhythmias would enable pre-emptive actions to prevent sudden cardiac arrest/death. A deep learning-enabled single-lead ambulatory electrocardiogram (ECG) may identify an ECG profile of individuals at imminent risk of sustained ventricular tachycardia (VT). METHODS: This retrospective study included 247 254, 14 day ambulatory ECG recordings from six countries. The first 24 h were used to identify patients likely to experience sustained VT occurrence (primary outcome) in the subsequent 13 days using a deep learning-based model. The development set consisted of 183 177 recordings. Performance was evaluated using internal (n = 43 580) and external (n = 20 497) validation data sets. Saliency mapping visualized features influencing the model's risk predictions. RESULTS: Among all recordings, 1104 (.5%) had sustained ventricular arrhythmias. In both the internal and external validation sets, the model achieved an area under the receiver operating characteristic curve of .957 [95% confidence interval (CI) .943-.971] and .948 (95% CI .926-.967). For a specificity fixed at 97.0%, the sensitivity reached 70.6% and 66.1% in the internal and external validation sets, respectively. The model accurately predicted future VT occurrence of recordings with rapid sustained VT (≥180 b.p.m.) in 80.7% and 81.1%, respectively, and 90.0% of VT that degenerated into ventricular fibrillation. Saliency maps suggested the role of premature ventricular complex burden and early depolarization time as predictors for VT. CONCLUSIONS: A novel deep learning model utilizing dynamic single-lead ambulatory ECGs accurately identifies patients at near-term risk of ventricular arrhythmias. It also uncovers an early depolarization pattern as a potential determinant of ventricular arrhythmias events.

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