Evaluating atrial fibrillation artificial intelligence for the emergency department, statistical and clinical implications

Objective: An artificial intelligence (AI) algorithm has been developed to detect the electrocardiographic signature of atrial fibrillation (AF) present on an electrocardiogram (ECG) obtained during normal sinus rhythm. We evaluated the ability of this algorithm to predict incident AF in an emergency department (ED) cohort of patients presenting with palpitations without concurrent AF. Methods: This retrospective study included patients 18 years and older who presented with palpitations to one of 15 ED sites and had a 12‑lead ECG performed. Patients with prior AF or newly diagnosed AF during the ED visit were excluded. Of the remaining patients, those with a follow up ECG or Holter monitor in the subsequent year were included. We evaluated the performance of the AI-ECG output to predict incident AF within one year of the index ECG by estimating an area under the receiver operating characteristics curve (AUC). Sensitivity, specificity, and positive and negative predictive values were determined at the optimum threshold (maximizing sensitivity and specificity), and thresholds by output decile for the sample. Results: A total of 1403 patients were included. Forty-three (3.1%) patients were diagnosed with new AF during the following year. The AI-ECG algorithm predicted AF with an AUC of 0.74 (95% CI 0.68–0.80), and an optimum threshold with sensitivity 79.1% (95% Confidence Interval (CI) 66.9%–91.2%), and specificity 66.1% (95% CI 63.6%–68.6%). Conclusions: We found this AI-ECG AF algorithm to maintain statistical significance in predicting incident AF, with clinical utility for screening purposes limited in this ED population with a low incidence of AF.