Detection of Atrial Fibrillation in Holter ECG Recordings by ECHOView Images: A Deep Transfer Learning Study

<b>Background/Objectives</b>: The timely and accurate detection of atrial fibrillation (AF) is critical from a clinical perspective. Detecting short or transient AF events is challenging in 24-72 h Holter ECG recordings, especially when symptoms are infrequent. This study aims to explore the potential of deep transfer learning with ImageNet deep neural networks (DNNs) to improve the interpretation of short-term ECHOView images for the presence of AF. <b>Methods</b>: Thirty-second ECHOView images, composed of stacked heartbeat amplitudes, were rescaled to fit the input of 18 pretrained ImageNet DNNs with the top layers modified for binary classification (AF, non-AF). Transfer learning provided both retrained DNNs by training only the top layers (513-2048 trainable parameters) and fine-tuned DNNs by slowly training retrained DNNs (0.38-23.48 M parameters). <b>Results</b>: Transfer learning used 13,536 training and 6624 validation samples from the two leads in the IRIDIA-AF Holter ECG database, evenly split between AF and non-AF cases. The top-ranked DNNs evaluated on 11,400 test samples from independent records are the retrained EfficientNetV2B1 (96.3% accuracy with minimal inter-patient (1%) and inter-lead (0.3%) drops), and fine-tuned EfficientNetV2B1 and DenseNet-121, -169, -201 (97.2-97.6% accuracy with inter-patient (1.4-1.6%) and inter-lead (0.5-1.2%) drops). These models can process shorter ECG episodes with a tolerable accuracy drop of up to 0.6% for 20 s and 4-15% for 10 s. Case studies present the GradCAM heatmaps of retrained EfficientNetV2B1 overlaid on raw ECG and ECHOView images to illustrate model interpretability. <b>Conclusions</b>: In an extended deep transfer learning study, we validate that ImageNet DNNs applied to short-term ECHOView images through retraining and fine-tuning can significantly enhance automated AF diagnoses. GradCAM heatmaps provide meaningful model interpretability, highlighting ECG regions of interest aligned with cardiologist focus.