Integration of EHR and ECG Data for Predicting Paroxysmal Atrial Fibrillation in Stroke Patients

Predicting paroxysmal atrial fibrillation (PAF) is challenging due to its transient nature. Existing methods often rely solely on electrocardiogram (ECG) waveforms or Electronic Health Record (EHR)-based clinical risk factors. We hypothesized that explicitly balancing the contributions of these heterogeneous data sources could improve prediction accuracy. We developed a Transformer-based deep learning model that integrates 12-lead ECG signals and 47 structured EHR variables from 189 patients with cryptogenic stroke, including 49 with PAF. By systematically varying the relative contributions of ECG and EHR data, we identified an optimal ratio for prediction. Best performance (accuracy: 0.70, sensitivity: 0.72, specificity: 0.87, Area Under Curve - Receiver Operating Characteristics (AUROC): 0.65, Area Under the Precision-Recall Curve (AUPRC): 0.43) was achieved using a 5-fold cross-validation when EHR data contributed one-third and ECG data two-thirds of the model's input. This multimodal approach outperformed unimodal models, improving accuracy by 35% over EHR-only and 5% over ECG-only methods. Our results support the value of combining ECG and structured EHR information to improve accuracy and sensitivity in this pilot cohort, motivating validation in larger studies.