Detecting QT prolongation From a Single-lead ECG With Deep Learning

Background and Aims For a number of antiarrhythmics, drug loading requires a 3-day hospitalization with monitoring for QT-prolongation. Automated QT monitoring with wearable ECG monitors would facilitate out-of-hospital care. We aim to develop a deep learning model that infers QT intervals from ECG lead-I – the lead most often acquired from ambulatory ECG monitors – and we use this model to detect clinically meaningful QT-prolongation episodes during Dofetilide drug loading. Methods Using 4.22 million 12-lead ECG recordings from 903.6 thousand patients at the Massachusetts General Hospital, we develop a deep learning model, QTNet, that infers QT intervals from lead-I. Over 3 million ECGs from 653 thousand patients are used to train the model and an internal-test set containing 633 thousand ECGs from 135 thousand patients was used for testing. QTNet is further evaluated on an external-validation set containing 3.1 million ECGs from 667 thousand patients at another institution. QTNet was used to detect Dofetilide-induced QT prolongation in a publicly available database (ECGRDVQ-dataset) containing ECGs from subjects enrolled in a clinical trial evaluating the effects of antiarrhythmic drugs. Results QTNet achieves mean absolute errors of 12.63ms (internal-test) and 12.30ms (external-validation) for estimating absolute QT intervals. The associated Pearson correlation coefficients are 0.91 (internal-test) and 0.92 (external-validation). For the ECGRDVQ-dataset, QTNet detects Dofetilide-induced QTc prolongation with 87% sensitivity and 77% specificity. The negative predictive value of the model is greater than 95% when the pre-test probability of drug-induced QTc prolongation is below 25%. Conclusions Drug-induced QT prolongation risk can be tracked from ECG lead-I using deep learning. This research leads the path toward out-of-hospital care using wearable ECG devices for antiarrhythmic therapies. What’s New? Using only Lead-I ECG, a novel deep neural network, QTNet, can estimate the QT intervals that are similar to those generated from the 12-lead ECG by the clinical ECG machines, with a mean absolute error of 12ms and a Pearson correlation coefficient of 0.91. The same QTNet, when applied without any fine-tuning on an external population undergoing Dofetilide loading, can identify whether and when clinically critical QT prolongation occurs after the drug loading. In comparison to manual annotations of QT intervals by clinical experts, QTNet achieves 87% sensitivity and 77% specificity. QTNet is a novel regression model that can be used on Lead-I ECG streams, potentially from wearable devices at out-of-hospital settings, for health critical applications such as drug-induced QT prolongation tracking.