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Yue X, Zhou L, Li Y, Zhao C. Multidisciplinary management strategies for atrial fibrillation. Curr Probl Cardiol 2024; 49:102514. [PMID: 38518845 DOI: 10.1016/j.cpcardiol.2024.102514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/13/2024] [Indexed: 03/24/2024]
Abstract
There has been a significant increase in the prevalence of atrial fibrillation (AF) over the past 30 years. Pulmonary vein isolation (PVI) is an effective treatment for AF, but research investigations have shown that AF recurrence still occurs in a significant number of patients after ablation. Heart rhythm outcomes following catheter ablation are correlated with numerous clinical factors, and researchers developed predictive models by integrating risk factors to predict the risk of recurrence of atrial fibrillation. The purpose of this article is to outline the risk scores for predicting cardiac rhythm outcomes after PVI and to discuss the modifiable factors that increase the risk of recurrence of AF, with the hope of further improving catheter ablation efficacy through preoperative identification of high-risk populations and postoperative management of modifiable risk factors.
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Affiliation(s)
- Xindi Yue
- Division of Cardiology, Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Ling Zhou
- Division of Cardiology, Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yahui Li
- Division of Cardiology, Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Chunxia Zhao
- Division of Cardiology, Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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Brahier MS, Zou F, Abdulkareem M, Kochi S, Migliarese F, Thomaides A, Ma X, Wu C, Sandfort V, Bergquist PJ, Srichai MB, Piccini JP, Petersen SE, Vargas JD. Using machine learning to enhance prediction of atrial fibrillation recurrence after catheter ablation. J Arrhythm 2023; 39:868-875. [PMID: 38045451 PMCID: PMC10692862 DOI: 10.1002/joa3.12927] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/22/2023] [Accepted: 09/03/2023] [Indexed: 12/05/2023] Open
Abstract
Background Traditional risk scores for recurrent atrial fibrillation (AF) following catheter ablation utilize readily available clinical and echocardiographic variables and yet have limited discriminatory capacity. Use of data from cardiac imaging and deep learning may help improve accuracy and prediction of recurrent AF after ablation. Methods We evaluated patients with symptomatic, drug-refractory AF undergoing catheter ablation. All patients underwent pre-ablation cardiac computed tomography (cCT). LAVi was computed using a deep-learning algorithm. In a two-step analysis, random survival forest (RSF) was used to generate prognostic models with variables of highest importance, followed by Cox proportional hazard regression analysis of the selected variables. Events of interest included early and late recurrence. Results Among 653 patients undergoing AF ablation, the most important factors associated with late recurrence by RSF analysis at 24 (+/-18) months follow-up included LAVi and early recurrence. In total, 5 covariates were identified as independent predictors of late recurrence: LAVi (HR per mL/m2 1.01 [1.01-1.02]; p < .001), early recurrence (HR 2.42 [1.90-3.09]; p < .001), statin use (HR 1.38 [1.09-1.75]; p = .007), beta-blocker use (HR 1.29 [1.01-1.65]; p = .043), and adjunctive cavotricuspid isthmus ablation [HR 0.74 (0.57-0.96); p = .02]. Survival analysis demonstrated that patients with both LAVi >66.7 mL/m2 and early recurrence had the highest risk of late recurrence risk compared with those with LAVi <66.7 mL/m2 and no early recurrence (HR 4.52 [3.36-6.08], p < .001). Conclusions Machine learning-derived, full volumetric LAVi from cCT is the most important pre-procedural risk factor for late AF recurrence following catheter ablation. The combination of increased LAVi and early recurrence confers more than a four-fold increased risk of late recurrence.
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Affiliation(s)
- Mark S. Brahier
- Georgetown University Medical CenterWashingtonDCUSA
- Duke University HospitalDurhamNorth CarolinaUSA
| | | | - Musa Abdulkareem
- Barts Heart CentreBarts Health National Health Service (NHS) TrustLondonUnited Kingdom
- National Institute for Health Research (NIHR) Barts Biomedical Research Centre, William Harvey Research InstituteQueen Mary University of LondonLondonUnited Kingdom
- Health Data Research UKLondonUnited Kingdom
| | | | | | | | - Xiaoyang Ma
- Georgetown University Medical CenterWashingtonDCUSA
| | - Colin Wu
- National Heart, Lung, and Blood InstituteBethesdaMarylandUSA
| | | | | | | | | | - Steffen E. Petersen
- Barts Heart CentreBarts Health National Health Service (NHS) TrustLondonUnited Kingdom
- National Institute for Health Research (NIHR) Barts Biomedical Research Centre, William Harvey Research InstituteQueen Mary University of LondonLondonUnited Kingdom
- Health Data Research UKLondonUnited Kingdom
- The Alan Turing InstituteLondonUnited Kingdom
| | - Jose D. Vargas
- Georgetown University Medical CenterWashingtonDCUSA
- Veterans Affairs Medical CenterWashingtonDCUSA
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Tateishi R, Suzuki M, Shimizu M, Shimada H, Tsunoda T, Miyazaki H, Misu Y, Yamakami Y, Yamaguchi M, Kato N, Isshiki A, Kimura S, Fujii H, Nishizaki M, Sasano T. Risk prediction of inappropriate implantable cardioverter-defibrillator therapy using machine learning. Sci Rep 2023; 13:19586. [PMID: 37949876 PMCID: PMC10638417 DOI: 10.1038/s41598-023-46095-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023] Open
Abstract
We aimed to develop machine learning-based predictive models for identifying inappropriate implantable cardioverter-defibrillator (ICD) therapy. Our study included 182 consecutive cases (average age 62.2 ± 4.5 years, 169 men) and employed 14 non-deep learning models for prediction (hold-out method). These models utilized selected electrocardiogram parameters and clinical features collected after ICD implantation. From the feature importance analysis of the best ML model, we established easily calculable scores. Among the patients, 25 (13.7%) experienced inappropriate therapy, and we identified 16 significant predictors. Using recursive feature elimination with cross-validation, we reduced the features to six with high feature importance: history of atrial arrhythmia (Atr-arrhythm), ischemic cardiomyopathy (ICM), absence of diabetes mellitus (DM), lack of cardiac resynchronization therapy (CRT), V3 ST level at J point (V3 STJ), and V5 R-wave amplitudes (V5R amp). The extra-trees classifier yielded the highest area under receiver operating characteristics curve (AUROC; 0.869 on test data). Thus, the Cardi35 score was defined as [+ 5.5*Atr-arrhythm - 1.5*CRT + 1.0*V3STJ + 1.0*V5R - 1.0*ICM - 0.5*DM], which demonstrated a hazard ratio of 1.62 (P < 0.001). A cut-off value of the score + 5.5 showed high AUROC (0.826). The ML approach can yield a robust prediction model, and the Cardi35 score was a convenient predictor for inappropriate therapy.
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Affiliation(s)
- Ryo Tateishi
- Department of Cardiology, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuura-Higashi, Kanazawa-ku, Yokohama, Japan
| | - Makoto Suzuki
- Department of Cardiology, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuura-Higashi, Kanazawa-ku, Yokohama, Japan.
| | - Masato Shimizu
- Department of Cardiology, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuura-Higashi, Kanazawa-ku, Yokohama, Japan
| | - Hiroshi Shimada
- Department of Cardiology, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuura-Higashi, Kanazawa-ku, Yokohama, Japan
| | - Takahiro Tsunoda
- Department of Cardiology, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuura-Higashi, Kanazawa-ku, Yokohama, Japan
| | - Hiroko Miyazaki
- Department of Cardiology, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuura-Higashi, Kanazawa-ku, Yokohama, Japan
| | - Yoshiki Misu
- Department of Cardiology, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuura-Higashi, Kanazawa-ku, Yokohama, Japan
| | - Yosuke Yamakami
- Department of Cardiology, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuura-Higashi, Kanazawa-ku, Yokohama, Japan
| | - Masao Yamaguchi
- Department of Cardiology, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuura-Higashi, Kanazawa-ku, Yokohama, Japan
| | - Nobutaka Kato
- Department of Cardiology, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuura-Higashi, Kanazawa-ku, Yokohama, Japan
| | - Ami Isshiki
- Department of Cardiology, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuura-Higashi, Kanazawa-ku, Yokohama, Japan
| | - Shigeki Kimura
- Department of Cardiology, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuura-Higashi, Kanazawa-ku, Yokohama, Japan
| | - Hiroyuki Fujii
- Department of Cardiology, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuura-Higashi, Kanazawa-ku, Yokohama, Japan
| | | | - Tetsuo Sasano
- Department of Cardiology, Tokyo Medical and Dental University, Tokyo, Japan
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Feng R, Deb B, Ganesan P, Tjong FVY, Rogers AJ, Ruipérez-Campillo S, Somani S, Clopton P, Baykaner T, Rodrigo M, Zou J, Haddad F, Zahari M, Narayan SM. Segmenting computed tomograms for cardiac ablation using machine learning leveraged by domain knowledge encoding. Front Cardiovasc Med 2023; 10:1189293. [PMID: 37849936 PMCID: PMC10577270 DOI: 10.3389/fcvm.2023.1189293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 09/18/2023] [Indexed: 10/19/2023] Open
Abstract
Background Segmentation of computed tomography (CT) is important for many clinical procedures including personalized cardiac ablation for the management of cardiac arrhythmias. While segmentation can be automated by machine learning (ML), it is limited by the need for large, labeled training data that may be difficult to obtain. We set out to combine ML of cardiac CT with domain knowledge, which reduces the need for large training datasets by encoding cardiac geometry, which we then tested in independent datasets and in a prospective study of atrial fibrillation (AF) ablation. Methods We mathematically represented atrial anatomy with simple geometric shapes and derived a model to parse cardiac structures in a small set of N = 6 digital hearts. The model, termed "virtual dissection," was used to train ML to segment cardiac CT in N = 20 patients, then tested in independent datasets and in a prospective study. Results In independent test cohorts (N = 160) from 2 Institutions with different CT scanners, atrial structures were accurately segmented with Dice scores of 96.7% in internal (IQR: 95.3%-97.7%) and 93.5% in external (IQR: 91.9%-94.7%) test data, with good agreement with experts (r = 0.99; p < 0.0001). In a prospective study of 42 patients at ablation, this approach reduced segmentation time by 85% (2.3 ± 0.8 vs. 15.0 ± 6.9 min, p < 0.0001), yet provided similar Dice scores to experts (93.9% (IQR: 93.0%-94.6%) vs. 94.4% (IQR: 92.8%-95.7%), p = NS). Conclusions Encoding cardiac geometry using mathematical models greatly accelerated training of ML to segment CT, reducing the need for large training sets while retaining accuracy in independent test data. Combining ML with domain knowledge may have broad applications.
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Affiliation(s)
- Ruibin Feng
- Department of Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, United States
| | - Brototo Deb
- Department of Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, United States
| | - Prasanth Ganesan
- Department of Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, United States
| | - Fleur V. Y. Tjong
- Department of Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, United States
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Albert J. Rogers
- Department of Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, United States
| | - Samuel Ruipérez-Campillo
- Department of Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, United States
- Bioengineering Department, University of California, Berkeley, Berkeley, CA, United States
| | - Sulaiman Somani
- Department of Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, United States
| | - Paul Clopton
- Department of Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, United States
| | - Tina Baykaner
- Department of Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, United States
| | - Miguel Rodrigo
- Department of Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, United States
- CoMMLab, Universitat Politècnica de València, Valencia, Spain
| | - James Zou
- Department of Biomedical Data Science, Stanford University, Stanford, CA, United States
| | - Francois Haddad
- Department of Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, United States
| | - Matei Zahari
- Department of Computer Science, Stanford University, Stanford, CA, United States
| | - Sanjiv M. Narayan
- Department of Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, United States
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Kar SS, Cetin H, Abraham J, Srivastava SK, Whitney J, Madabhushi A, Ehlers JP. Novel Fractal-Based Sub-RPE Compartment OCT Radiomics Biomarkers Are Associated With Subfoveal Geographic Atrophy in Dry AMD. IEEE Trans Biomed Eng 2023; 70:2914-2921. [PMID: 37097804 PMCID: PMC10581743 DOI: 10.1109/tbme.2023.3270201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
OBJECTIVE The purpose of this study was to quantitatively characterize the shape of the sub-retinal pigment epithelium (sub-RPE, i.e., space bounded by RPE and Bruch's membrane) compartment on SD-OCT using fractal dimension (FD) features and evaluate their impact on risk of subfoveal geographic atrophy (sfGA) progression. METHODS This was an IRB-approved retrospective study of 137 subjects with dry age-related macular degeneration (AMD) with subfoveal GA. Based on sfGA status at year five, eyes were categorized as "Progressors" and "Non-progressors". FD analysis allows quantification of the degree of shape complexity and architectural disorder associated with a structure. To characterize the structural irregularities along the sub-RPE surface between the two groups of patients, a total of 15 shape descriptors of FD were extracted from the sub-RPE compartment of baseline OCT scans. The top four features were identified using minimum Redundancy maximum Relevance (mRmR) feature selection method and evaluated with Random Forest (RF) classifier using three-fold cross validation from the training set (N = 90). Classifier performance was subsequently validated on the independent test set (N = 47). RESULTS Using the top four FD features, a RF classifier yielded an AUC of 0.85 on the independent test set. Mean fractal entropy (p-value = 4.8e-05) was identified as the most significant biomarker; higher values of entropy being associated with greater shape disorder and risk for sfGA progression. CONCLUSIONS FD assessment holds promise for identifying high-risk eyes for GA progression. SIGNIFICANCE With further validation, FD features could be potentially used for clinical trial enrichment and assessments for therapeutic response in dry AMD patients.
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Lyu Y, Bennamoun M, Sharif N, Lip GYH, Dwivedi G. Artificial Intelligence in the Image-Guided Care of Atrial Fibrillation. Life (Basel) 2023; 13:1870. [PMID: 37763273 PMCID: PMC10532509 DOI: 10.3390/life13091870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/19/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
Atrial fibrillation arises mainly due to abnormalities in the cardiac conduction system and is associated with anatomical remodeling of the atria and the pulmonary veins. Cardiovascular imaging techniques, such as echocardiography, computed tomography, and magnetic resonance imaging, are crucial in the management of atrial fibrillation, as they not only provide anatomical context to evaluate structural alterations but also help in determining treatment strategies. However, interpreting these images requires significant human expertise. The potential of artificial intelligence in analyzing these images has been repeatedly suggested due to its ability to automate the process with precision comparable to human experts. This review summarizes the benefits of artificial intelligence in enhancing the clinical care of patients with atrial fibrillation through cardiovascular image analysis. It provides a detailed overview of the two most critical steps in image-guided AF management, namely, segmentation and classification. For segmentation, the state-of-the-art artificial intelligence methodologies and the factors influencing the segmentation performance are discussed. For classification, the applications of artificial intelligence in the diagnosis and prognosis of atrial fibrillation are provided. Finally, this review also scrutinizes the current challenges hindering the clinical applicability of these methods, with the aim of guiding future research toward more effective integration into clinical practice.
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Affiliation(s)
- Yiheng Lyu
- Department of Computer Science and Software Engineering, School of Physics, Mathematics and Computing, The University of Western Australia, Perth, WA 6009, Australia; (Y.L.); (M.B.)
- Harry Perkins Institute of Medical Research, The University of Western Australia, Perth, WA 6009, Australia
| | - Mohammed Bennamoun
- Department of Computer Science and Software Engineering, School of Physics, Mathematics and Computing, The University of Western Australia, Perth, WA 6009, Australia; (Y.L.); (M.B.)
| | - Naeha Sharif
- Department of Computer Science and Software Engineering, School of Physics, Mathematics and Computing, The University of Western Australia, Perth, WA 6009, Australia; (Y.L.); (M.B.)
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool L69 3BX, UK
- Liverpool John Moores University, Liverpool L3 5UX, UK
- Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, 9220 Aalborg, Denmark
| | - Girish Dwivedi
- Harry Perkins Institute of Medical Research, The University of Western Australia, Perth, WA 6009, Australia
- Department of Cardiology, Fiona Stanley Hospital, Perth, WA 6150, Australia
- Medical School, The University of Western Australia, Perth, WA 6009, Australia
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Razeghi O, Kapoor R, Alhusseini MI, Fazal M, Tang S, Roney CH, Rogers AJ, Lee A, Wang PJ, Clopton P, Rubin DL, Narayan SM, Niederer S, Baykaner T. Atrial fibrillation ablation outcome prediction with a machine learning fusion framework incorporating cardiac computed tomography. J Cardiovasc Electrophysiol 2023; 34:1164-1174. [PMID: 36934383 PMCID: PMC10857794 DOI: 10.1111/jce.15890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 03/06/2023] [Accepted: 03/14/2023] [Indexed: 03/20/2023]
Abstract
BACKGROUND Structural changes in the left atrium (LA) modestly predict outcomes in patients undergoing catheter ablation for atrial fibrillation (AF). Machine learning (ML) is a promising approach to personalize AF management strategies and improve predictive risk models after catheter ablation by integrating atrial geometry from cardiac computed tomography (CT) scans and patient-specific clinical data. We hypothesized that ML approaches based on a patient's specific data can identify responders to AF ablation. METHODS Consecutive patients undergoing AF ablation, who had preprocedural CT scans, demographics, and 1-year follow-up data, were included in the study for a retrospective analysis. The inputs of models were CT-derived morphological features from left atrial segmentation (including the shape, volume of the LA, LA appendage, and pulmonary vein ostia) along with deep features learned directly from raw CT images, and clinical data. These were merged intelligently in a framework to learn their individual importance and produce the optimal classification. RESULTS Three hundred twenty-one patients (64.2 ± 10.6 years, 69% male, 40% paroxysmal AF) were analyzed. Post 10-fold nested cross-validation, the model trained to intelligently merge and learn appropriate weights for clinical, morphological, and imaging data (AUC 0.821) outperformed those trained solely on clinical data (AUC 0.626), morphological (AUC 0.659), or imaging data (AUC 0.764). CONCLUSION Our ML approach provides an end-to-end automated technique to predict AF ablation outcomes using deep learning from CT images, derived structural properties of LA, augmented by incorporation of clinical data in a merged ML framework. This can help develop personalized strategies for patient selection in invasive management of AF.
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Affiliation(s)
- Orod Razeghi
- King’s College, London, UK
- University College London, London, UK
| | | | | | | | - Siyi Tang
- Stanford University, California, USA
| | | | | | - Anson Lee
- Stanford University, California, USA
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Ishii M, Kaikita K, Yasuda S, Akao M, Ako J, Matoba T, Nakamura M, Miyauchi K, Hagiwara N, Kimura K, Hirayama A, Nishihara E, Nakamura S, Matsui K, Ogawa H, Tsujita K. Risk prediction score for clinical outcome in atrial fibrillation and stable coronary artery disease. Open Heart 2023; 10:openhrt-2023-002292. [PMID: 37173099 DOI: 10.1136/openhrt-2023-002292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVE Antithrombotic therapy is essential for patients with atrial fibrillation (AF) and stable coronary artery disease (CAD) because of the high risk of thrombosis, whereas a combination of antiplatelets and anticoagulants is associated with a high risk of bleeding. We sought to develop and validate a machine-learning-based model to predict future adverse events. METHODS Data from 2215 patients with AF and stable CAD enrolled in the Atrial Fibrillation and Ischaemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease trial were randomly assigned to the development and validation cohorts. Using the random survival forest (RSF) and Cox regression models, risk scores were developed for net adverse clinical events (NACE) defined as all-cause death, myocardial infarction, stroke or major bleeding. RESULTS Using variables selected by the Boruta algorithm, RSF and Cox models demonstrated acceptable discrimination and calibration in the validation cohort. Using the variables weighted by HR (age, sex, body mass index, systolic blood pressure, alcohol consumption, creatinine clearance, heart failure, diabetes, antiplatelet use and AF type), an integer-based risk score for NACE was developed and classified patients into three risk groups: low (0-4 points), intermediate (5-8) and high (≥9). In both cohorts, the integer-based risk score performed well, with acceptable discrimination (area under the curve 0.70 and 0.66, respectively) and calibration (p>0.40 for both). Decision curve analysis showed the superior net benefits of the risk score. CONCLUSIONS This risk score can predict the risk of NACE in patients with AF and stable CAD. TRIAL REGISTRATION NUMBERS UMIN000016612, NCT02642419.
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Affiliation(s)
- Masanobu Ishii
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Koichi Kaikita
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Tetsuya Matoba
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Katsumi Miyauchi
- Department of Cardiovascular Medicine, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Kazuo Kimura
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | | | | | - Shinichiro Nakamura
- Priority Organization for Innovation and Excellence Laboratory for Data Science, Kumamoto University, Kumamoto, Japan
| | - Kunihiko Matsui
- Department of General Medicine and Primary Care, Kumamoto University Hospital, Kumamoto, Japan
| | | | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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Ogbomo-Harmitt S, Muffoletto M, Zeidan A, Qureshi A, King AP, Aslanidi O. Exploring interpretability in deep learning prediction of successful ablation therapy for atrial fibrillation. Front Physiol 2023; 14:1054401. [PMID: 36998987 PMCID: PMC10043207 DOI: 10.3389/fphys.2023.1054401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 02/28/2023] [Indexed: 03/16/2023] Open
Abstract
Background: Radiofrequency catheter ablation (RFCA) therapy is the first-line treatment for atrial fibrillation (AF), the most common type of cardiac arrhythmia globally. However, the procedure currently has low success rates in dealing with persistent AF, with a reoccurrence rate of ∼50% post-ablation. Therefore, deep learning (DL) has increasingly been applied to improve RFCA treatment for AF. However, for a clinician to trust the prediction of a DL model, its decision process needs to be interpretable and have biomedical relevance.Aim: This study explores interpretability in DL prediction of successful RFCA therapy for AF and evaluates if pro-arrhythmogenic regions in the left atrium (LA) were used in its decision process.Methods: AF and its termination by RFCA have been simulated in MRI-derived 2D LA tissue models with segmented fibrotic regions (n = 187). Three ablation strategies were applied for each LA model: pulmonary vein isolation (PVI), fibrosis-based ablation (FIBRO) and a rotor-based ablation (ROTOR). The DL model was trained to predict the success of each RFCA strategy for each LA model. Three feature attribution (FA) map methods were then used to investigate interpretability of the DL model: GradCAM, Occlusions and LIME.Results: The developed DL model had an AUC (area under the receiver operating characteristic curve) of 0.78 ± 0.04 for predicting the success of the PVI strategy, 0.92 ± 0.02 for FIBRO and 0.77 ± 0.02 for ROTOR. GradCAM had the highest percentage of informative regions in the FA maps (62% for FIBRO and 71% for ROTOR) that coincided with the successful RFCA lesions known from the 2D LA simulations, but unseen by the DL model. Moreover, GradCAM had the smallest coincidence of informative regions of the FA maps with non-arrhythmogenic regions (25% for FIBRO and 27% for ROTOR).Conclusion: The most informative regions of the FA maps coincided with pro-arrhythmogenic regions, suggesting that the DL model leveraged structural features of MRI images to identify such regions and make its prediction. In the future, this technique could provide a clinician with a trustworthy decision support tool.
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Ma Y, Zhang D, Xu J, Pang H, Hu M, Li J, Zhou S, Guo L, Yi F. Explainable machine learning model reveals its decision-making process in identifying patients with paroxysmal atrial fibrillation at high risk for recurrence after catheter ablation. BMC Cardiovasc Disord 2023; 23:91. [PMID: 36803424 PMCID: PMC9936738 DOI: 10.1186/s12872-023-03087-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/23/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND A number of models have been reported for predicting atrial fibrillation (AF) recurrence after catheter ablation. Although many machine learning (ML) models were developed among them, black-box effect existed widely. It was always difficult to explain how variables affect model output. We sought to implement an explainable ML model and then reveal its decision-making process in identifying patients with paroxysmal AF at high risk for recurrence after catheter ablation. METHODS Between January 2018 and December 2020, 471 consecutive patients with paroxysmal AF who had their first catheter ablation procedure were retrospectively enrolled. Patients were randomly assigned into training cohort (70%) and testing cohort (30%). The explainable ML model based on Random Forest (RF) algorithm was developed and modified on training cohort, and tested on testing cohort. In order to gain insight into the association between observed values and model output, Shapley additive explanations (SHAP) analysis was used to visualize the ML model. RESULTS In this cohort, 135 patients experienced tachycardias recurrences. With hyperparameters adjusted, the ML model predicted AF recurrence with an area under the curve of 66.7% in the testing cohort. Summary plots listed the top 15 features in descending order and preliminary showed the association between features and outcome prediction. Early recurrence of AF showed the most positive impact on model output. Dependence plots combined with force plots showed the impact of single feature on model output, and helped determine high risk cut-off points. The thresholds of CHA2DS2-VASc score, systolic blood pressure, AF duration, HAS-BLED score, left atrial diameter and age were 2, 130 mmHg, 48 months, 2, 40 mm and 70 years, respectively. Decision plot recognized significant outliers. CONCLUSION An explainable ML model effectively revealed its decision-making process in identifying patients with paroxysmal atrial fibrillation at high risk for recurrence after catheter ablation by listing important features, showing the impact of every feature on model output, determining appropriate thresholds and identifying significant outliers. Physicians can combine model output, visualization of model and clinical experience to make better decision.
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Affiliation(s)
- Yibo Ma
- grid.233520.50000 0004 1761 4404Department of Cardiology, Xijing Hospital, Air Force Medical University, 169 Changle West Road, Xi’an, 710032 Shaanxi China
| | - Dong Zhang
- grid.233520.50000 0004 1761 4404Department of Cardiology, Xijing Hospital, Air Force Medical University, 169 Changle West Road, Xi’an, 710032 Shaanxi China
| | - Jian Xu
- grid.233520.50000 0004 1761 4404Department of Cardiology, Xijing Hospital, Air Force Medical University, 169 Changle West Road, Xi’an, 710032 Shaanxi China
| | - Huani Pang
- grid.233520.50000 0004 1761 4404Department of Cardiology, Xijing Hospital, Air Force Medical University, 169 Changle West Road, Xi’an, 710032 Shaanxi China
| | - Miaoyang Hu
- grid.233520.50000 0004 1761 4404Department of Cardiology, Xijing Hospital, Air Force Medical University, 169 Changle West Road, Xi’an, 710032 Shaanxi China
| | - Jie Li
- grid.233520.50000 0004 1761 4404Department of Cardiology, Xijing Hospital, Air Force Medical University, 169 Changle West Road, Xi’an, 710032 Shaanxi China
| | - Shiqiang Zhou
- grid.233520.50000 0004 1761 4404Department of Cardiology, Xijing Hospital, Air Force Medical University, 169 Changle West Road, Xi’an, 710032 Shaanxi China
| | - Lanyan Guo
- grid.233520.50000 0004 1761 4404Department of Cardiology, Xijing Hospital, Air Force Medical University, 169 Changle West Road, Xi’an, 710032 Shaanxi China
| | - Fu Yi
- Department of Cardiology, Xijing Hospital, Air Force Medical University, 169 Changle West Road, Xi'an, 710032, Shaanxi, China.
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11
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Tang S, Razeghi O, Kapoor R, Alhusseini MI, Fazal M, Rogers AJ, Bort MR, Clopton P, Wang P, Rubin D, Narayan SM, Baykaner T. Machine Learning-Enabled Multimodal Fusion of Intra-Atrial and Body Surface Signals in Prediction of Atrial Fibrillation Ablation Outcomes. Circ Arrhythm Electrophysiol 2022; 15:e010850. [PMID: 35867397 PMCID: PMC9972736 DOI: 10.1161/circep.122.010850] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Machine learning is a promising approach to personalize atrial fibrillation management strategies for patients after catheter ablation. Prior atrial fibrillation ablation outcome prediction studies applied classical machine learning methods to hand-crafted clinical scores, and none have leveraged intracardiac electrograms or 12-lead surface electrocardiograms for outcome prediction. We hypothesized that (1) machine learning models trained on electrograms or electrocardiogram (ECG) signals can perform better at predicting patient outcomes after atrial fibrillation ablation than existing clinical scores and (2) multimodal fusion of electrogram, ECG, and clinical features can further improve the prediction of patient outcomes. METHODS Consecutive patients who underwent catheter ablation between 2015 and 2017 with panoramic left atrial electrogram before ablation and clinical follow-up for at least 1 year following ablation were included. Convolutional neural network and a novel multimodal fusion framework were developed for predicting 1-year atrial fibrillation recurrence after catheter ablation from electrogram, ECG signals, and clinical features. The models were trained and validated using 10-fold cross-validation on patient-level splits. RESULTS One hundred fifty-six patients (64.5±10.5 years, 74% male, 42% paroxysmal) were analyzed. Using electrogram signals alone, the convolutional neural network achieved an area under the receiver operating characteristics curve (AUROC) of 0.731, outperforming the existing APPLE scores (AUROC=0.644) and CHA2DS2-VASc scores (AUROC=0.650). Similarly using 12-lead ECG alone, the convolutional neural network achieved an AUROC of 0.767. Combining electrogram, ECG, and clinical features, the fusion model achieved an AUROC of 0.859, outperforming single and dual modality models. CONCLUSIONS Deep neural networks trained on electrogram or ECG signals improved the prediction of catheter ablation outcome compared with existing clinical scores, and fusion of electrogram, ECG, and clinical features further improved the prediction. This suggests the promise of using machine learning to help treatment planning for patients after catheter ablation.
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Affiliation(s)
| | - Orod Razeghi
- University College London, Centre for Advanced Research Computing, London, United Kingdom
| | | | | | | | | | - Miguel Rodrigo Bort
- Stanford University, Stanford, CA,CoMMLab, Universitat de Valencia, VA, Spain
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12
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Bray JJH, Hanif MA, Alradhawi M, Ibbetson J, Dosanjh SS, Smith SL, Ahmad M, Pimenta D. Machine learning applications in cardiac computed tomography: a composite systematic review. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac018. [PMID: 35919128 PMCID: PMC9242067 DOI: 10.1093/ehjopen/oeac018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/10/2022] [Indexed: 12/02/2022]
Abstract
Artificial intelligence and machine learning (ML) models are rapidly being applied to the analysis of cardiac computed tomography (CT). We sought to provide an overview of the contemporary advances brought about by the combination of ML and cardiac CT. Six searches were performed in Medline, Embase, and the Cochrane Library up to November 2021 for (i) CT-fractional flow reserve (CT-FFR), (ii) atrial fibrillation (AF), (iii) aortic stenosis, (iv) plaque characterization, (v) fat quantification, and (vi) coronary artery calcium score. We included 57 studies pertaining to the aforementioned topics. Non-invasive CT-FFR can accurately be estimated using ML algorithms and has the potential to reduce the requirement for invasive angiography. Coronary artery calcification and non-calcified coronary lesions can now be automatically and accurately calculated. Epicardial adipose tissue can also be automatically, accurately, and rapidly quantified. Effective ML algorithms have been developed to streamline and optimize the safety of aortic annular measurements to facilitate pre-transcatheter aortic valve replacement valve selection. Within electrophysiology, the left atrium (LA) can be segmented and resultant LA volumes have contributed to accurate predictions of post-ablation recurrence of AF. In this review, we discuss the latest studies and evolving techniques of ML and cardiac CT.
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Affiliation(s)
- Jonathan James Hyett Bray
- Institute of Life Sciences 2, Swansea University Medical, School , Swansea, UK
- Cardiology Department, Royal Free Hospital, Royal Free London NHS Foundation Trust , London, UK
| | - Moghees Ahmad Hanif
- Cardiology Department, Royal Free Hospital, Royal Free London NHS Foundation Trust , London, UK
| | | | - Jacob Ibbetson
- Cardiology Department, Royal Free Hospital, Royal Free London NHS Foundation Trust , London, UK
| | | | - Sabrina Lucy Smith
- Barts and the London School of Medicine and Dentistry , London E1 2AD, UK
| | - Mahmood Ahmad
- Cardiology Department, Royal Free Hospital, Royal Free London NHS Foundation Trust , London, UK
- University College London Medical School , London WC1E 6DE, UK
| | - Dominic Pimenta
- Richmond Research Institute, St George’s Hospital, University of London , Cranmer Terrace, Tooting, London SW17 0RE, UK
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Nedios S, Iliodromitis K, Kowalewski C, Bollmann A, Hindricks G, Dagres N, Bogossian H. Big Data in electrophysiology. Herzschrittmacherther Elektrophysiol 2022; 33:26-33. [PMID: 35137276 DOI: 10.1007/s00399-022-00837-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 01/07/2022] [Indexed: 06/14/2023]
Abstract
The quantity of data produced and captured in medicine today is unprecedented. Technological improvements and automation have expanded the traditional statistical methods and enabled the analysis of Big Data. This has permitted the discovery of new associations with a granularity that was previously hidden to human eyes. In the first part of this review, the authors would like to provide an overview of basic Machine Learning (ML) principles and techniques in order to better understand their application in recent publications about cardiac arrhythmias. In the second part, ML-enabled advances in disease detection and diagnosis, outcome prediction, and novel disease characterization in topics like electrocardiography, atrial fibrillation, ventricular arrhythmias, and cardiac devices are presented. Finally, the limitations and challenges of applying ML in clinical practice, such as validation, replication, generalizability, and regulatory issues, are discussed. More carefully designed studies and collaborations are needed for ML to become feasible, trustworthy, accurate, and reproducible and to reach its full potential for patient-oriented precision medicine.
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Affiliation(s)
- Sotirios Nedios
- Department of Electrophysiology, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany.
- Rhythmologie, Herzzentrum Leipzig, Universität Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.
| | - Konstantinos Iliodromitis
- Department of Cardiology and Rhythmology, Ev. Krankenhaus Hagen, Hagen, Germany
- Department of Cardiology, University Witten/Herdecke, Witten, Germany
| | - Christopher Kowalewski
- Department of Electrophysiology, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
| | - Harilaos Bogossian
- Department of Cardiology and Rhythmology, Ev. Krankenhaus Hagen, Hagen, Germany
- Department of Cardiology, University Witten/Herdecke, Witten, Germany
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14
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Park JW, Kwon OS, Shim J, Hwang I, Kim YG, Yu HT, Kim TH, Uhm JS, Kim JY, Choi JI, Joung B, Lee MH, Kim YH, Pak HN. Machine Learning-Predicted Progression to Permanent Atrial Fibrillation After Catheter Ablation. Front Cardiovasc Med 2022; 9:813914. [PMID: 35252393 PMCID: PMC8890475 DOI: 10.3389/fcvm.2022.813914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction We developed a prediction model for atrial fibrillation (AF) progression and tested whether machine learning (ML) could reproduce the prediction power in an independent cohort using pre-procedural non-invasive variables alone. Methods Cohort 1 included 1,214 patients and cohort 2, 658, and all underwent AF catheter ablation (AFCA). AF progression to permanent AF was defined as sustained AF despite repeat AFCA or cardioversion under antiarrhythmic drugs. We developed a risk stratification model for AF progression (STAAR score) and stratified cohort 1 into three groups. We also developed an ML-prediction model to classify three STAAR risk groups without invasive parameters and validated the risk score in cohort 2. Results The STAAR score consisted of a stroke (2 points, p = 0.003), persistent AF (1 point, p = 0.049), left atrial (LA) dimension ≥43 mm (1 point, p = 0.010), LA voltage <1.109 mV (2 points, p = 0.004), and PR interval ≥196 ms (1 point, p = 0.001), based on multivariate Cox analyses, and it had a good discriminative power for progression to permanent AF [area under curve (AUC) 0.796, 95% confidence interval (CI): 0.753–0.838]. The ML prediction model calculated the risk for AF progression without invasive variables and achieved excellent risk stratification: AUC 0.935 for low-risk groups (score = 0), AUC 0.855 for intermediate-risk groups (score 1–3), and AUC 0.965 for high-risk groups (score ≥ 4) in cohort 1. The ML model successfully predicted the high-risk group for AF progression in cohort 2 (log-rank p < 0.001). Conclusions The ML-prediction model successfully classified the high-risk patients who will progress to permanent AF after AFCA without invasive variables but has a limited discrimination power for the intermediate-risk group.
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Affiliation(s)
- Je-Wook Park
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Oh-Seok Kwon
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Jaemin Shim
- Department of Internal Medicine, Korea University Cardiovascular Center, Seoul, South Korea
- *Correspondence: Jaemin Shim
| | - Inseok Hwang
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Yun Gi Kim
- Department of Internal Medicine, Korea University Cardiovascular Center, Seoul, South Korea
| | - Hee Tae Yu
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Jae-Sun Uhm
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Jong-Youn Kim
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Jong Il Choi
- Department of Internal Medicine, Korea University Cardiovascular Center, Seoul, South Korea
| | - Boyoung Joung
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Young-Hoon Kim
- Department of Internal Medicine, Korea University Cardiovascular Center, Seoul, South Korea
| | - Hui-Nam Pak
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
- Hui-Nam Pak
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15
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Roney CH, Sim I, Yu J, Beach M, Mehta A, Alonso Solis-Lemus J, Kotadia I, Whitaker J, Corrado C, Razeghi O, Vigmond E, Narayan SM, O’Neill M, Williams SE, Niederer SA. Predicting Atrial Fibrillation Recurrence by Combining Population Data and Virtual Cohorts of Patient-Specific Left Atrial Models. Circ Arrhythm Electrophysiol 2022; 15:e010253. [PMID: 35089057 PMCID: PMC8845531 DOI: 10.1161/circep.121.010253] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 01/03/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Current ablation therapy for atrial fibrillation is suboptimal, and long-term response is challenging to predict. Clinical trials identify bedside properties that provide only modest prediction of long-term response in populations, while patient-specific models in small cohorts primarily explain acute response to ablation. We aimed to predict long-term atrial fibrillation recurrence after ablation in large cohorts, by using machine learning to complement biophysical simulations by encoding more interindividual variability. METHODS Patient-specific models were constructed for 100 atrial fibrillation patients (43 paroxysmal, 41 persistent, and 16 long-standing persistent), undergoing first ablation. Patients were followed for 1 year using ambulatory ECG monitoring. Each patient-specific biophysical model combined differing fibrosis patterns, fiber orientation maps, electrical properties, and ablation patterns to capture uncertainty in atrial properties and to test the ability of the tissue to sustain fibrillation. These simulation stress tests of different model variants were postprocessed to calculate atrial fibrillation simulation metrics. Machine learning classifiers were trained to predict atrial fibrillation recurrence using features from the patient history, imaging, and atrial fibrillation simulation metrics. RESULTS We performed 1100 atrial fibrillation ablation simulations across 100 patient-specific models. Models based on simulation stress tests alone showed a maximum accuracy of 0.63 for predicting long-term fibrillation recurrence. Classifiers trained to history, imaging, and simulation stress tests (average 10-fold cross-validation area under the curve, 0.85±0.09; recall, 0.80±0.13; precision, 0.74±0.13) outperformed those trained to history and imaging (area under the curve, 0.66±0.17) or history alone (area under the curve, 0.61±0.14). CONCLUSION A novel computational pipeline accurately predicted long-term atrial fibrillation recurrence in individual patients by combining outcome data with patient-specific acute simulation response. This technique could help to personalize selection for atrial fibrillation ablation.
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Affiliation(s)
- Caroline H. Roney
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
- School of Engineering and Materials Science, Queen Mary University of London, United Kingdom (C.H.R.)
| | - Iain Sim
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - Jin Yu
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - Marianne Beach
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - Arihant Mehta
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - Jose Alonso Solis-Lemus
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - Irum Kotadia
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - John Whitaker
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
- The Department of Internal Medicine, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (J.W.)
| | - Cesare Corrado
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - Orod Razeghi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - Edward Vigmond
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (E.V.)
- Univ. Bordeaux, IMB, UMR 5251, F-33400 Talence, France (E.V.)
| | - Sanjiv M. Narayan
- Department of Medicine and Cardiovascular Institute, Stanford University, Palo Alto, CA (S.M.N.)
| | - Mark O’Neill
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - Steven E. Williams
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
- Centre for Cardiovascular Science, College of Medicine and Veterinary Medicine, University of Edinburgh (S.E.W.)
| | - Steven A. Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
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16
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Roney CH, Sillett C, Whitaker J, Lemus JAS, Sim I, Kotadia I, O'Neill M, Williams SE, Niederer SA. Applications of multimodality imaging for left atrial catheter ablation. Eur Heart J Cardiovasc Imaging 2021; 23:31-41. [PMID: 34747450 PMCID: PMC8685603 DOI: 10.1093/ehjci/jeab205] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Indexed: 11/13/2022] Open
Abstract
Atrial arrhythmias, including atrial fibrillation and atrial flutter, may be treated through catheter ablation. The process of atrial arrhythmia catheter ablation, which includes patient selection, pre-procedural planning, intra-procedural guidance, and post-procedural assessment, is typically characterized by the use of several imaging modalities to sequentially inform key clinical decisions. Increasingly, advanced imaging modalities are processed via specialized image analysis techniques and combined with intra-procedural electrical measurements to inform treatment approaches. Here, we review the use of multimodality imaging for left atrial ablation procedures. The article first outlines how imaging modalities are routinely used in the peri-ablation period. We then describe how advanced imaging techniques may inform patient selection for ablation and ablation targets themselves. Ongoing research directions for improving catheter ablation outcomes by using imaging combined with advanced analyses for personalization of ablation targets are discussed, together with approaches for their integration in the standard clinical environment. Finally, we describe future research areas with the potential to improve catheter ablation outcomes.
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Affiliation(s)
- Caroline H Roney
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| | - Charles Sillett
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| | - John Whitaker
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| | | | - Iain Sim
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| | - Irum Kotadia
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| | - Mark O'Neill
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| | - Steven E Williams
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
- Centre for Cardiovascular Science, The University of Edinburgh, Scotland, UK
| | - Steven A Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
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Tseng AS, Noseworthy PA. Prediction of Atrial Fibrillation Using Machine Learning: A Review. Front Physiol 2021; 12:752317. [PMID: 34777014 PMCID: PMC8581234 DOI: 10.3389/fphys.2021.752317] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/04/2021] [Indexed: 02/01/2023] Open
Abstract
There has been recent immense interest in the use of machine learning techniques in the prediction and screening of atrial fibrillation, a common rhythm disorder present with significant clinical implications primarily related to the risk of ischemic cerebrovascular events and heart failure. Prior to the advent of the application of artificial intelligence in clinical medicine, previous studies have enumerated multiple clinical risk factors that can predict the development of atrial fibrillation. These clinical parameters include previous diagnoses, laboratory data (e.g., cardiac and inflammatory biomarkers, etc.), imaging data (e.g., cardiac computed tomography, cardiac magnetic resonance imaging, echocardiography, etc.), and electrophysiological data. These data are readily available in the electronic health record and can be automatically queried by artificial intelligence algorithms. With the modern computational capabilities afforded by technological advancements in computing and artificial intelligence, we present the current state of machine learning methodologies in the prediction and screening of atrial fibrillation as well as the implications and future direction of this rapidly evolving field.
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Affiliation(s)
- Andrew S Tseng
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
| | - Peter A Noseworthy
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
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The Role of Artificial Intelligence and Machine Learning in Clinical Cardiac Electrophysiology. Can J Cardiol 2021; 38:246-258. [PMID: 34333029 DOI: 10.1016/j.cjca.2021.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/11/2021] [Accepted: 07/25/2021] [Indexed: 11/21/2022] Open
Abstract
In recent years, artificial intelligence (AI) has found numerous applications in cardiology due in part to large digitized datasets and the evolution of high performance computing. In the discipline of cardiac electrophysiology (EP), a number of clinical, imaging, and electrical waveform data are considered in the diagnosis, prognostication and management of arrhythmias, which lend themselves well to automation through AI. But equally relevant, AI offers a unique opportunity to discover novel EP concepts and improve clinical care through its inherent, hierarchical tenets of self-learning. This review will focus on the application of AI in clinical EP and summarize state-of-the art, large, clinical studies in the following key domains: (1) ECG-based arrhythmia and disease classification, (2) atrial fibrillation source detection, (3) substrate and risk assessment for atrial fibrillation and ventricular tachyarrhythmias, and (4) predicting outcomes after cardiac resynchronization therapy. Many are small, single-center, proof-of-concept investigations, but they still demonstrate groundbreaking performance of deep learning, a subdomain of AI, which surpasses traditional statistical analysis. Larger studies, for instance classifying arrhythmias from ECG recordings, have further provided external validation of their high accuracy. Ultimately, the performance of AI is dependent on the quality of the input data and the rigor of algorithm development. The field is still nascent and several barriers will need to be overcome, including prospective validation in large, well-labelled datasets and more seamless information technology-based data collection/integration, before AI can be adopted into broader clinical EP practice. This review will conclude with a discussion of these challenges and future work.
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Nedios S, Lindemann F, Heijman J, Crijns HJGM, Bollmann A, Hindricks G. Atrial remodeling and atrial fibrillation recurrence after catheter ablation : Past, present, and future developments. Herz 2021; 46:312-317. [PMID: 34223914 DOI: 10.1007/s00059-021-05050-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 12/30/2022]
Abstract
The term "atrial remodeling" is used to describe the electrical, mechanical, and structural changes associated with the presence of an arrhythmogenic substrate for atrial fibrillation. Rhythm control therapy may slow down or even reverse progressive atrial remodeling. Atrial remodeling has long been recognized as an important predictor of clinical outcomes and therapeutic success, but recent advances have highlighted its clinical relevance and revealed the implications of specific anatomical changes such as atrial asymmetry or shape. This has opened the path to computational precision medicine that captures these data in detail and combines them with other factors, to provide patient-specific solutions. The goal of precision medicine lies in improving clinical outcomes, reducing costs, and avoiding unnecessary procedures. In this article, we review the history of atrial remodeling and we summarize the insights from our research on anatomical atrial remodeling and its association with rhythm outcomes after catheter ablation. Finally, we present recent advances in the field, reflecting the beginning of a new technological era that will enable us to improve patient care by personalized patient-specific medicine.
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Affiliation(s)
- Sotirios Nedios
- Department of Electrophysiology, Heart Center at University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.
| | - Frank Lindemann
- Department of Electrophysiology, Heart Center at University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany
| | - Jordi Heijman
- Department of Cardiology, CardiovascularResearch Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Harry J G M Crijns
- Department of Cardiology, CardiovascularResearch Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center at University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center at University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany
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Lee JH, Kwon OS, Shim J, Lee J, Han HJ, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Kim YH, Pak HN. Left Atrial Wall Stress and the Long-Term Outcome of Catheter Ablation of Atrial Fibrillation: An Artificial Intelligence-Based Prediction of Atrial Wall Stress. Front Physiol 2021; 12:686507. [PMID: 34276406 PMCID: PMC8285096 DOI: 10.3389/fphys.2021.686507] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/11/2021] [Indexed: 12/19/2022] Open
Abstract
Atrial stretch may contribute to the mechanism of atrial fibrillation (AF) recurrence after atrial fibrillation catheter ablation (AFCA). We tested whether the left atrial (LA) wall stress (LAW-stress[measured]) could be predicted by artificial intelligence (AI) using non-invasive parameters (LAW-stress[AI]) and whether rhythm outcome after AFCA could be predicted by LAW-stress[AI] in an independent cohort. Cohort 1 included 2223 patients, and cohort 2 included 658 patients who underwent AFCA. LAW-stress[measured] was calculated using the Law of Laplace using LA diameter by echocardiography, peak LA pressure measured during procedure, and LA wall thickness measured by customized software (AMBER) using computed tomography. The highest quartile (Q4) LAW-stress[measured] was predicted and validated by AI using non-invasive clinical parameters, including non-paroxysmal type of AF, age, presence of hypertension, diabetes, vascular disease, and heart failure, left ventricular ejection fraction, and the ratio of the peak mitral flow velocity of the early rapid filling to the early diastolic velocity of the mitral annulus (E/Em). We tested the AF/atrial tachycardia recurrence 3 months after the blanking period after AFCA using the LAW-stress[measured] and LAW-stress[AI] in cohort 1 and LAW-stress[AI] in cohort 2. LAW-stress[measured] was independently associated with non-paroxysmal AF (p < 0.001), diabetes (p = 0.012), vascular disease (p = 0.002), body mass index (p < 0.001), E/Em (p < 0.001), and mean LA voltage measured by electrogram voltage mapping (p < 0.001). The best-performing AI model had acceptable prediction power for predicting Q4-LAW-stress[measured] (area under the receiver operating characteristic curve 0.734). During 26.0 (12.0–52.0) months of follow-up, AF recurrence was significantly higher in the Q4-LAW-stress[measured] group [log-rank p = 0.001, hazard ratio 2.43 (1.21–4.90), p = 0.013] and Q4-LAW-stress[AI] group (log-rank p = 0.039) in cohort 1. In cohort 2, the Q4-LAW-stress[AI] group consistently showed worse rhythm outcomes (log-rank p < 0.001). A higher LAW-stress was associated with poorer rhythm outcomes after AFCA. AI was able to predict this complex but useful prognostic parameter using non-invasive parameters with moderate accuracy.
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Affiliation(s)
- Jae-Hyuk Lee
- Department of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Oh-Seok Kwon
- Department of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Jaemin Shim
- Department of Cardiology, Korea University Cardiovascular Center, Seoul, South Korea
| | - Jisu Lee
- Department of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Hee-Jin Han
- Department of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Hee Tae Yu
- Department of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Tae-Hoon Kim
- Department of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Jae-Sun Uhm
- Department of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Boyoung Joung
- Department of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Moon-Hyoung Lee
- Department of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Young-Hoon Kim
- Department of Cardiology, Korea University Cardiovascular Center, Seoul, South Korea
| | - Hui-Nam Pak
- Department of Cardiology, Yonsei University Health System, Seoul, South Korea
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