Abstract 4370080: Detection of indication-relevant and incidental arrhythmias on ambulatory ECG recordings by artificial intelligence compared to ECG technicians

Background: In the DRAI MARTINI study, the DeepRhythmAI (DRAI) algorithm had a superior sensitivity for arrhythmia detection compared to ECG technicians. However, it has not been reported whether the additional arrhythmias that were detected were directly relevant to the indication for ambulatory monitoring or were incidental. Methods: We included n=14,606 patients with 14±10 days of continuous ambulatory ECG that was analysed beat-to-beat by both DRAI and ECG technicians (n=167). In patients monitored for tachyarrhythmia (known or suspected atrial fibrillation (AF), palpitations, or transient ischemic attack or stroke) AF, supraventricular tachycardias (SVTs), ectopic atrial rhythm (EAR), ventricular tachycardia (VT) or idioventricular rhythm (IVR) were considered relevant findings, while 2 nd or 3 rd degree atrioventricular block (AVB) and pauses/asystoles >2.0/3.5s incidental. In patients monitored for bradycardia (syncope or dizziness) any finding of AVB, pause/asystole, VT, and IVR were considered relevant, whereas EAR, SVT and AF incidental. DRAI and technicians were compared to annotations by a panel of three experts, and confidence intervals (CIs) were derived using bootstrapping with 1,000 replications. Results: The sensitivity for both monitoring indications (tachyarrhythmia and bradycardia) was superior for DRAI compared to technicians. In patients monitored for tachyarrhythmia, the sensitivity for relevant arrhythmias was 99.5% (95%CI 98.8-100.0%) for AI vs. 67.9% (95%CI 62.9-71.8%) for technicians. The corresponding rates of arrhythmia detection were 221/1,000 patient-recordings (95%CI 209-234) for AI vs. 142/1000 patient-recordings (95%CI 131-153) for technicians. In patients monitored for bradycardia, the sensitivity for relevant arrhythmias was 99.4% for DRAI vs 54.6% (95%CI 45.3-61.9%) for technicians, and the corresponding rates of arrhythmia detection 115/1,000 patient-recordings (95%CI 104-126) vs 64/1,000 patient-recordings (95%CI 57-71). DRAI also had higher sensitivity for incidental findings, 98.5% (95%CI 96.3-100%) vs 49.2% (95%CI 41.3-56.2%) in patients monitored for tachyarrhythmias and 99.7% (95%CI 99.3-99.9%) vs 77.2% (95%CI 65.8-86.5%) in patients monitored for bradycardia. True positive rates for relevant and incidental findings are shown in Figure 1a-d. Conclusion: Analysis with DRAI has a superior sensitivity compared to technicians both for arrhythmias relevant to the monitoring indication and for incidental findings.