Predicting Short- and Long-term Future Occurrence of Atrial Fibrillation from Single-Lead ECG in Normal Sinus Rhythm with an Explainable Deep Learning Model.

项目总结/摘要 全世界有超过3000万人被诊断患有心房纤颤（AF），然而，另一个 13%的AF患者未被诊断。房颤患者中风风险增加五倍 多达三分之一的中风与房颤有关。及时给予适当的 预防性治疗，特别是抗凝剂，可以显著减少AF的并发症， 包括中风，降低了65%，死亡率降低了30%。 数字健康技术为识别未确诊的AF患者提供了新的方法， 阵发性房颤（PAF），其特征为持续时间有限的偶尔发作， 12-在临床环境中进行的导联心电图（ECG）不太可能与AF事件重叠。 持续监测是有希望的，但对于年龄较大的老年人来说，仍然是昂贵和负担沉重的。 更高的风险。 为了最大限度地提高这些技术的诊断率，我们提出了预测未来的新方法 正常窦性心律期间单导联ECG显示AF的发生。直到最近才显示， 根据收集的正常窦性心律下的12导联心电图， 临床环境。在这里，我们建议用市售的单- 这将为非临床环境中的早期检测提供可扩展的替代方案。 为了实现这一目标，我们将回顾性分析10，000多人的原始单导联ECG数据 在14天的监测中。然后，将在一组独特的1，718个样本中进行验证工作 参加AF筛查前瞻性mSToPS临床试验的无症状个体（平均 年龄73岁），具有完整的临床信息和合并症。该项目的三个目标是： 1.计算正常窦性心律个体在短期内发生未来房颤事件的概率 使用经典的单导联ECG特征和基于表示学习的特征。 2.开发一种方法，通过评估在以下研究中检测到的AF个体，长期预测AF发作： 从正常窦性心律的初始监测期开始的1、3、6和12个月，并通过验证 使用mSToPS数据集的算法，具有3年临床随访和注释的合并症。 3.开发一种技术来提供表征学习特征的初步解释， 应用于短期和长期预测的时间序列数据。 这项回顾性研究将开发和优化单导联ECG的新预测技术， 通过消费者设备提供，目的是识别患有AF的高风险个体。 根据这项研究的结果，未来的发展方向将包括对房颤预测的前瞻性研究 使用消费者单导联心电图来改善临床结果。

Project Summary/Abstract More than 30 million individuals worldwide are diagnosed with atrial fibrillation (AF), however, another 13% of individuals with AF are left undiagnosed. People with AF have a five-fold increased risk of stroke with up to one-third of all strokes shown to be related to AF. Timely administration of appropriate preventative therapies, especially anticoagulants, can significantly decrease the complications of AF, including strokes, by 65% and mortality by 30%. Digital health technologies offer new approaches to identify individuals with undiagnosed AF, in particular paroxysmal AF (PAF), characterized by occasional episodes of limited duration, for whom a 10-second 12-lead electrocardiography (ECG) performed in the clinical setting is unlikely to overlap with an AF event. Continuous monitoring is promising, but still costly and burdensome for elderly individuals, who are at higher risk. To maximize the diagnostic yield of these technologies, we propose novel methods to predict the future occurrence of AF from a single-lead ECG during normal sinus rhythm. Only recently it was shown that it is possible to predict the future occurrence of AF from 12-lead ECGs in normal sinus rhythm collected in a clinical setting. Here, we propose to predict the occurrence of AF with commercially available single- lead ECG devices, which will enable a scalable alternative for early detection in a non-clinical setting. To achieve this goal, we will analyze retrospectively the raw single-lead ECG data of 10,000+ individuals with PAF over 14 days of monitoring. Validation work will then be carried out in a unique set of 1,718 asymptomatic individuals who participated in the prospective mSToPS clinical trial of AF screening (mean age 73), with full clinical information and co-morbidities. The three aims of this project are: 1. Compute the probability of a future AF event in the short-term for an individual in normal sinus rhythm using classic single-lead ECG features and representation learning based features. 2. Develop a method for long-term prediction of AF onset by evaluating individuals with AF detected in 1, 3, 6 and 12 months from the initial monitored period of normal sinus rhythm and by validating the algorithms using the mSToPS dataset with 3 years of clinical follow-up and annotated co-morbidities. 3. Develop a technique to provide a preliminary interpretation of representation learning features for time-series data applied to the short- and long-term prediction. This retrospective study will develop and optimize new predictive techniques from single-lead ECGs, available through consumer devices, with the goal of identifying individuals at high risk of developing AF. A future direction to build on from this study's results would include a prospective study of AF prediction using consumer single-lead ECG to improve clinical outcomes.