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Predicting Recurrence and Outcomes After Stressor-Associated Atrial Fibrillation Using ECG-Based Deep Learning.

使用基于心电图的深度学习预测应激相关心房颤动后的复发和结局。

📚 期刊: J Am Heart Assoc 📅 发表: 2026-03-20 🔬 PMID: 41859908 🔗 DOI: 10.1161/JAHA.125.047146 👁️ 浏览: 18

👤 作者: Julian S Haimovich, Samuel Friedman, Christopher Reeder, Valentina Dsouza, Thomas Sommers, Keisuke Usuda, Shinwan Kany, Emelia J Benjamin, Steven A Lubitz, Mahnaz Maddah, Patrick T Ellinor, Shaan Khurshid

房颤

📝 摘要

Stressor-associated atrial fibrillation (AF) refers to new-onset AF that occurs with a reversible, acute stressor. Identifying individuals at highest risk for AF recurrence is essential to guide management. Although clinical factors have shown limited value, the utility of contemporary artificial intelligence (AI)-enabled models using the 12-lead ECG to estimate recurrence risk remains unknown. We retrospectively analyzed consecutive primary care and cardiology patients with stressor-associated AF occurring during hospitalization. We quantified the cumulative incidence of recurrence accounting for death as a competing risk. We investigated the relationship between time-varying recurrence and a composite end point of AF-related adverse events (stroke, heart failure, all-cause death) using Cox models. We then developed and validated a penalized regression model to predict recurrence using clinical factors, stressor type, and AF risk estimates from a previously validated ECG-based AI model. We analyzed 3371 patients with stressor-associated AF (mean age, 69±12 years; 40% women). Over a median of 3.7 years (interquartile range, 1.8-7.2), the 10-year cumulative incidence of AF recurrence was 41% (95% CI, 39-44). AF recurrence was strongly associated with AF-related adverse events (hazard ratio, 2.24 [95% CI, 1.81-2.76]). A model incorporating clinical factors, stressor type, and ECG-based AI model AF risk estimates (clinical-AI) discriminated AF recurrence (area under the receiver operating characteristic curve, 0.768 [95% CI, 0.707-0.830]) favorably compared with clinical features (area under the receiver operating characteristic curve, 0.707 [95% CI, 0.642-0.772]; AF recurrence rates following stressor-associated AF are considerable and are associated with substantially higher risk of adverse cardiovascular events. Models incorporating ECG-based AI risk estimates may prioritize individuals for intensive monitoring and preventive interventions.
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