Discriminating electrocardiographic responses to His-bundle pacing using machine learning.
File(s)1-s2.0-S2666693620300050-main.pdf (1.2 MB)
Published version
OA Location
Author(s)
Type
Journal Article
Abstract
Background: His-bundle pacing (HBP) has emerged as an alternative to conventional ventricular pacing because of its ability to deliver physiological ventricular activation. Pacing at the His bundle produces different electrocardiographic (ECG) responses: selective His-bundle pacing (S-HBP), non-selective His bundle pacing (NS-HBP), and myocardium-only capture (MOC). These 3 capture types must be distinguished from each other, which can be challenging and time-consuming even for experts. Objective: The purpose of this study was to use artificial intelligence (AI) in the form of supervised machine learning using a convolutional neural network (CNN) to automate HBP ECG interpretation. Methods: We identified patients who had undergone HBP and extracted raw 12-lead ECG data during S-HBP, NS-HBP, and MOC. A CNN was trained, using 3-fold cross-validation, on 75% of the segmented QRS complexes labeled with their capture type. The remaining 25% was kept aside as a testing dataset. Results: The CNN was trained with 1297 QRS complexes from 59 patients. Cohen kappa for the neural network's performance on the 17-patient testing set was 0.59 (95% confidence interval 0.30 to 0.88; P <.0001), with an overall accuracy of 75%. The CNN's accuracy in the 17-patient testing set was 67% for S-HBP, 71% for NS-HBP, and 84% for MOC. Conclusion: We demonstrated proof of concept that a neural network can be trained to automate discrimination between HBP ECG responses. When a larger dataset is trained to higher accuracy, automated AI ECG analysis could facilitate HBP implantation and follow-up and prevent complications resulting from incorrect HBP ECG analysis.
Date Issued
2020-08-28
Date Acceptance
2020-08-01
Citation
Cardiovascular Digital Health Journal, 2020, 1 (1), pp.11-20
Start Page
11
End Page
20
Journal / Book Title
Cardiovascular Digital Health Journal
Volume
1
Issue
1
Copyright Statement
© 2020 The Author(s). Published by Elsevier Inc. on behalf of Heart Rhythm Society.Thisisanopenaccessarticleunderthe CCBYlicense (http://creativecommons.org/licenses/by/4.0/)
License URL
Sponsor
British Heart Foundation
Imperial College Healthcare NHS Trust- BRC Funding
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/32954375
PII: S2666-6936(20)30005-0
Grant Number
RG/16/3/32175
RDB02
Subjects
Artificial intelligence
Conduction system pacing
Electrocardiography
His-bundle pacing
Machine learning
Neural networks
Pacemakers
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2020-08-28