Remote Atrial Fibrillation Burden Estimation Using Deep Recurrent Neural Network

Abstract

<italic>Objective:</italic> The atrial fibrillation burden (AFB) is defined as the percentage of time spent in atrial fibrillation (AF) over a long enough monitoring period. Recent research has suggested the added prognostic value of using the AFB compared to a binary diagnosis. We evaluate, for the first time, the ability to estimate the AFB over long-term continuous recordings, using a deep recurrent neutral network (DRNN) approach. <italic>Methods:</italic> The models were developed and evaluated on a large database of <italic>p</italic> = 2,891 patients, totaling <italic>t</italic> = 68,800 hours of continuous electrocardiography (ECG) recordings from the University of Virginia. Specifically, 24h beat-to-beat time series were obtained from a single portable ECG channel. The network, denoted ArNet, was benchmarked against a gradient boosting (XGB) model, trained on 21 features including the coefficient of sample entropy (CosEn) and AFEvidence that is derived from the number of irregular points revealed by the Lorenz plot. The generalizations of ArNet and XGB were also evaluated on the independent PhysioNet LTAF test database. Results: the absolute AF burden estimation error <inline-formula><tex-math notation= LaTeX >$| {{E_{AF}}({\\text{\\% }})} |$</tex-math></inline-formula>, median and interquartile, on the test set, was 1.2 (0.1-6.7) for ArNet and 2.8 (0.9-11.7) for XGB for AF individuals. Generalization results on LTAF were consistent with <inline-formula><tex-math notation= LaTeX >$| {{E_{AF}}({\\text{\\% }})} |$</tex-math></inline-formula> of 2.7 (1.1-14.7) for ArNet and 3.6 (1.0-16.7) for XGB. <italic>Conclusion:</italic> This research demonstrates the feasibility of AFB estimation from 24h beat-to-beat interval time series utilizing DRNNs. <italic>Significance:</italic> The novel data-driven approach enables robust remote diagnosis and phenotyping of AF.