Clinical perspectives on the adoption of the artificial intelligence-enabled electrocardiogram

The 12‑lead electrocardiogram (ECG) is a common and inexpensive diagnostic modality available at scale. The ECG reflects electrical activity throughout the cardiac cycle and is increasingly recognized to contain rich signal relevant across the spectrum of human conditions. Recent work has demonstrated that artificial intelligence (AI)-based algorithms may be able to extract latent information from within the 12‑lead ECG to classify the presence of disease and even predict the development of future disease. Despite recent development of many AI-based ECG algorithms, comparably few are used in routine clinical practice. Therefore, there is a critical unmet need to identify and mitigate potential barriers to the real-world clinical implementation of AI algorithms. We propose that the adoption of the AI-enabled ECG may be increased by future efforts focused on three key principles: a) maximizing credibility, b) optimizing practicality, and c) establishing clinical utility. In this mini-review, we discuss recent notable work focused on these principles and provide suggestions for future directions. AI-enabled ECG analysis possesses substantial potential to transform current methods to prevent, diagnose, and treat human disease, but a greater emphasis on their real-world application is required to bring that potential to reality.