An Artificial Intelligence-Enabled ECG Algorithm for Predicting the Risk of Recurrence in Patients with Paroxysmal Atrial Fibrillation after Catheter Ablation

Background: Catheter ablation (CA) is an important treatment strategy to reduce the burden and complications of atrial fibrillation (AF). This study aims to predict the risk of recurrence in patients with paroxysmal AF (pAF) after CA by an artificial intelligence (AI)-enabled electrocardiography (ECG) algorithm. Methods and Results: 1618 ≥ 18 years old patients with pAF who underwent CA in Guangdong Provincial People’s Hospital from 1 January 2012 to 31 May 2019 were enrolled in this study. All patients underwent pulmonary vein isolation (PVI) by experienced operators. Baseline clinical features were recorded in detail before the operation and standard follow-up (≥12 months) was conducted. The convolutional neural network (CNN) was trained and validated by 12-lead ECGs within 30 days before CA to predict the risk of recurrence. A receiver operating characteristic curve (ROC) was created for the testing and validation sets, and the predictive performance of AI-enabled ECG was assessed by the area under the curve (AUC). After training and internal validation, the AUC of the AI algorithm was 0.84 (95% CI: 0.78–0.89), with a sensitivity, specificity, accuracy, precision and balanced F Score (F1 score) of 72.3%, 95.0%, 92.0%, 69.1% and 0.707, respectively. Compared with current prognostic models (APPLE, BASE-AF2, CAAP-AF, DR-FLASH and MB-LATER), the performance of the AI algorithm was better (p < 0.01). Conclusions: The AI-enabled ECG algorithm seemed to be an effective method to predict the risk of recurrence in patients with pAF after CA. This is of great clinical significance in decision-making for personalized ablation strategies and postoperative treatment plans in patients with pAF.