A deep learning model to predict recurrence of atrial fibrillation after pulmonary vein isolation
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International Journal of Arrhythmia Open Access
RESEARCH
A deep learning model to predict recurrence of atrial fibrillation after pulmonary vein isolation Ju Youn Kim1, Younghoon Kim2, Gil‑Hwan Oh3, Sun Hwa Kim4, Young Choi5, Youmi Hwang6, Tae‑Seok Kim7, Sung‑Hwan Kim5, Ji‑Hoon Kim6, Sung‑Won Jang8, Yong‑Seog Oh5* and Man Young Lee9
Abstract Background and Objectives: The efficacy of radiofrequency catheter ablation (RFCA) in atrial fibrillation (AF) is well established. The standard approach to RFCA in AF is pulmonary vein isolation (PVI). However, a large proportion of patients experiences recurrence of atrial tachyarrhythmia. The purpose of this study is to find out whether the AI model can assess AF recurrence in patients who underwent PVI. Materials and methods: This study was a retrospective cohort study that enrolled consecutive patients who under‑ went catheter ablation for symptomatic, drug-refractory AF and PVI. We developed an AI algorithm to predict recur‑ rence of AF after PVI using patient demographics and three-dimensional (3D) reconstructed left atrium (LA) images. Results: We included 527 consecutive patients in the study. The overall mean LA diameter was 42.0 ± 6.8 mm, and the mean LA volume calculated using 3D reconstructed images was 151.1 ± 46.7 ml. During the follow-up period, atrial tachyarrhythmia recurred in 158 patients. The area under the curve (AUC) of the AI model based on a convolu‑ tional neural network (including 3D reconstruction images) was 0.61 (95% confidence interval [CI] 0.53–0.74) using the test dataset. The total test accuracy was 66.3% (57.0–75.6), and the sensitivity was 53.3% (34.8–71.9). The specificity was 73.2% (51.8–75.0), and the F1 score was 52.5% 34.5–66.7). Conclusion: In this study, we developed an AI algorithm to predict recurrence of AF after catheter ablation of PVI using individual reconstructed LA images. This AI model was unable to predict recurrence of AF overwhelmingly; therefore, further large-scale study is needed. Keywords: Left atrium, Atrial fibrillation, Pulmonary vein isolation, Catheter ablation Introduction The efficacy of radiofrequency catheter ablation (RFCA) in atrial fibrillation (AF) is well established [1]. Maintaining a normal sinus rhythm decreases the risk of stroke and heart failure [2, 3]. The standard approach for RFCA of AF is pulmonary vein isolation (PVI) for *Correspondence: [email protected] 5 Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo‑daero, Seocho‑gu, Seoul 06591, Republic of Korea Full list of author information is available at the end of the article
both paroxysmal and persistent AF because most triggers arise in the pulmonary veins [4, 5]. Nevertheless, many patients experience recurrence of atrial tachyarrhythmia and require repeat ablation. Many other strategies for adjuvant substrate modification are required to improve ablation outcomes [6, 7]. Still, the substrate modification group in a previous study did
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