Artificial intelligence and atrial fibrillation

Background: In the context of atrial fibrillation (AF), traditional clinical practices have thus fallen short in several domains, such as identifying patients at risk of incident AF or patients with concomitant undetected paroxysmal AF. Novel approaches leveraging artificial intelligence have the potential to provide new tools to deal with some of these old problems.

Aims: To discuss the roles of artificial intelligence (AI)-enabled electrocardiogram (ECG) pertaining to AF, potential roles of deep learning (DL) models in the context of current knowledge gaps, as well as limitations of these models.

Materials & methods: An extensive search and review of the currently available literature on the topics.

Results: One key area where DL models can translate to better patient outcomes is through automated ECG interpretation. Challenges with regards to the benefits and harms of AF screening remain. In this context, a unique model was developed to detect underlying hidden AF from sinus rhythm.

Discussion: Knowledge gaps remain regarding the best ways to monitor patients with embolic stroke of undetermined source (ESUS) and identifying those who would benefit most from oral anticoagulation. The AI-enabled AF model is one potential way to tackle this complex problem as it could be used to identify a subset of high-risk ESUS patients likely to benefit from empirical oral anticoagulation. The role of DL models assessing AF burden from long-duration ECG data is also discussed as a way of guiding management. There is a trend towards the use of consumer-grade wristbands and watches to detect AF from photoplethysmography data. However, ECG currently remains the gold standard to detect arrythmias including AF. Lastly, the role of adequate external validation of the models and clinical trials to study true performance is discussed.

Conclusion: Algorithms using AI to interpret ECGs in various new ways have been developed. While still, much work needs to be done, these technologies have shown enormous potential in a short span of time. With further advancements and continuous research, these novel ways of interpretation may well become part of everyday clinical workflow.