Semi-Supervised Learning for Automatic Atrial Fibrillation Detection in 24-Hour Holter Monitoring

Paroxysmal atrial fibrillation (AF) is generally diagnosed by long-term dynamic electrocardiogram (ECG) monitoring. Identifying AF episodes from long-term ECG data can place a heavy burden on clinicians. Many machine-learning-based automatic AF detection methods have been proposed to solve this issue. However, these methods require numerous annotated data to train the model, and the annotation of AF in long-term ECG is extremely time-consuming. Reducing the demand for labeled data can effectively improve the clinical practicability of automatic AF detection methods. In this study, we developed a novel semi-supervised learning method that generated modified low-entropy labels of unlabeled samples for training a deep learning model to automatically detect paroxysmal AF in 24 h Holter monitoring data. Our method employed a 1D CNN-LSTM neural network with RR intervals as input and used few labeled training data with numerous unlabeled data for training the neural network. This method was evaluated using a 24 h Holter monitoring dataset collected from 1000 paroxysmal AF patients. Using labeled samples from only 10 patients for model training, our method achieved a sensitivity of 97.8%, specificity of 97.9%, and accuracy of 97.9% in five-fold cross-validation. Compared to the supervised learning method with complete labeled samples, the detection accuracy of our method was only 0.5% lower, while the workload of data annotation was significantly reduced by more than 98%. In general, this is the first study to apply semi-supervised learning techniques for automatic AF detection using ECG. Our method can effectively reduce the demand for AF data annotations and can improve the clinical practicability of automatic AF detection.