12 lead surface ECGs as a surrogate of atrial electrical remodeling - a deep learning based approach

Atrial fibrillation (AF), a common arrhythmia, is linked with atrial electrical and structural changes, notably low voltage areas (LVAs) which are associated with poor ablation outcomes and increased thromboembolic risk. This study aims to evaluate the efficacy of a deep learning model applied to 12‑lead ECGs for non-invasively predicting the presence of LVAs, potentially guiding pre-ablation strategies and improving patient outcomes.

A retrospective analysis was conducted on 204 AF patients, who underwent catheter ablation. Pre-procedural sinus rhythm ECGs and electroanatomical maps (EAM) were utilized alongside demographic data to train a deep learning model combining Long Short-Term Memory networks and Convolutional Neural Networks with a cross-attention layer. Model performance was evaluated using a 5-fold cross-validation strategy.

The model effectively identified the presence of LVA on the examined atrial walls, achieving accuracies of 78 % for both the anterior and posterior walls, and 82 % for the LA roof. Moreover, it accurately predicted the global left atrial (LA) average voltage <0.7 mV, with an accuracy of 88 %.

The study showcases the potential of deep learning applied to 12‑lead ECGs to effectively predict regional LVAs and global LA voltage in AF patients non-invasively. This model offers a promising tool for the pre-ablation assessment of atrial substrate, facilitating personalized therapeutic strategies and potentially enhancing ablation success rates.