Multi-modal artificial intelligence algorithm for the prediction of left atrial low-voltage areas in atrial fibrillation patient based on sinus rhythm electrocardiogram and clinical characteristics: a retrospective, multicentre study.

Aims: We aimed to develop an artificial intelligence (AI) algorithm capable of accurately predicting the presence of left atrial low-voltage areas (LVAs) based on sinus rhythm electrocardiograms (ECGs) in patients with atrial fibrillation (AF).

Methods And Results: The study included 1133 patients with AF who underwent catheter ablation procedures, with a total of 1787 12-lead ECG images analysed. Artificial intelligence-based algorithms were used to construct models for predicting the presence of LVAs. The DR-FLASH and APPLE clinical scores for LVAs prediction were calculated. A receiver operating characteristic (ROC) curve and a calibration curve were used to evaluate model performance. Multicentre validation included 92 AF patients from five centres, with a total of 174 ECGs. The data obtained from the participants were split into training ( = 906), validation ( = 113), and test sets ( = 114). Low-voltage areas were detected in 47.4% of all participants. Using ECG alone, the convolutional neural network (CNN) model achieved an area under the ROC curve (AUROC) of 0.704, outperforming both the DR-FLASH score (AUROC = 0.601) and the APPLE score (AUROC = 0.589). Two multimodal AI models, which integrated ECG images and clinical features, demonstrated higher diagnostic accuracy (AUROC 0.816 and 0.796 for the CNN-Multimodal and CNN-Random Forest-Multimodal models, respectively). Our models also performed well in the multicentre validation dataset (AUROC 0.711, 0.785, and 0.879 for the ECG alone, CNN-Multimodal, and CNN-Random Forest-Multimodal models, respectively).

Conclusion: The multimodal AI algorithm, which integrated ECG images and clinical features, predicted the presence of LVAs with a higher degree of accuracy than ECG alone and the clinical LVA scores.