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      Big Data and Artificial Intelligence: Opportunities and Threats in Electrophysiology

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          Abstract

          The combination of big data and artificial intelligence (AI) is having an increasing impact on the field of electrophysiology. Algorithms are created to improve the automated diagnosis of clinical ECGs or ambulatory rhythm devices. Furthermore, the use of AI during invasive electrophysiological studies or combining several diagnostic modalities into AI algorithms to aid diagnostics are being investigated. However, the clinical performance and applicability of created algorithms are yet unknown. In this narrative review, opportunities and threats of AI in the field of electrophysiology are described, mainly focusing on ECGs. Current opportunities are discussed with their potential clinical benefits as well as the challenges. Challenges in data acquisition, model performance, (external) validity, clinical implementation, algorithm interpretation as well as the ethical aspects of AI research are discussed. This article aims to guide clinicians in the evaluation of new AI applications for electrophysiology before their clinical implementation.

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          Most cited references105

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          2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC).

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            Cardiologist-level arrhythmia detection and classification in ambulatory electrocardiograms using a deep neural network

            Computerized electrocardiogram (ECG) interpretation plays a critical role in the clinical ECG workflow1. Widely available digital ECG data and the algorithmic paradigm of deep learning2 present an opportunity to substantially improve the accuracy and scalability of automated ECG analysis. However, a comprehensive evaluation of an end-to-end deep learning approach for ECG analysis across a wide variety of diagnostic classes has not been previously reported. Here, we develop a deep neural network (DNN) to classify 12 rhythm classes using 91,232 single-lead ECGs from 53,549 patients who used a single-lead ambulatory ECG monitoring device. When validated against an independent test dataset annotated by a consensus committee of board-certified practicing cardiologists, the DNN achieved an average area under the receiver operating characteristic curve (ROC) of 0.97. The average F1 score, which is the harmonic mean of the positive predictive value and sensitivity, for the DNN (0.837) exceeded that of average cardiologists (0.780). With specificity fixed at the average specificity achieved by cardiologists, the sensitivity of the DNN exceeded the average cardiologist sensitivity for all rhythm classes. These findings demonstrate that an end-to-end deep learning approach can classify a broad range of distinct arrhythmias from single-lead ECGs with high diagnostic performance similar to that of cardiologists. If confirmed in clinical settings, this approach could reduce the rate of misdiagnosed computerized ECG interpretations and improve the efficiency of expert human ECG interpretation by accurately triaging or prioritizing the most urgent conditions.
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              Clinically applicable deep learning for diagnosis and referral in retinal disease

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                Author and article information

                Journal
                Arrhythm Electrophysiol Rev
                Arrhythm Electrophysiol Rev
                AER
                Arrhythmia & Electrophysiology Review
                Radcliffe Cardiology
                2050-3369
                2050-3377
                November 2020
                : 9
                : 3
                : 146-154
                Affiliations
                [1. ] Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
                [2. ] Department of Methodology and Statistics, Utrecht University, Utrecht, the Netherlands
                [3. ] Netherlands Heart Institute, Utrecht, the Netherlands
                [4. ] Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
                [5. ] Central Military Hospital Utrecht, Ministerie van Defensie, Utrecht, the Netherlands
                [6. ] Health Data Research UK and Institute of Health Informatics, University College London, London, UK
                Author notes

                Disclosure: The authors have no conflicts of interest to declare.

                Funding: This study was partly supported by The Netherlands Organisation for Health Research and Development (ZonMw, grant number 104021004) and partly supported by the Netherlands Cardiovascular Research Initiative, an initiative with support of the Dutch Heart Foundation (grant numbers CVON2015-12 eDETECT and QRS-VISION 2018B007). FWA is supported by UCL Hospitals NIHR Biomedical Research Center. AS is supported by the UMC Utrecht Alexandre Suerman MD/PhD programme.

                Correspondence: FW Asselbergs, Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, 3508 GA Utrecht, the Netherlands. E: f.w.asselbergs@ 123456umcutrecht.nl
                Article
                10.15420/aer.2020.26
                7675143
                33240510
                bee512fb-6ae1-4eff-82ec-08e7a67caff3
                Copyright © 2020, Radcliffe Cardiology

                This work is open access under the CC-BY-NC 4.0 License which allows users to copy, redistribute and make derivative works for non-commercial purposes, provided the original work is cited correctly.

                History
                : 08 June 2020
                : 03 August 2020
                Page count
                Pages: 9
                Categories
                Clinical Arrhythmias

                artificial intelligence,deep learning,neural networks,cardiology,electrophysiology,ecg,big data

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