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Luo Q, Zhu H, Zhu J, Li Y, Yu Y, Lei L, Lin F, Zhou M, Cui L, Zhu T, Li X, Zuo H, Yang X. Artificial intelligence-enabled 8-lead ECG detection of atrial septal defect among adults: a novel diagnostic tool. Front Cardiovasc Med 2023; 10:1279324. [PMID: 38028503 PMCID: PMC10679442 DOI: 10.3389/fcvm.2023.1279324] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background Patients with atrial septal defect (ASD) exhibit distinctive electrocardiogram (ECG) patterns. However, ASD cannot be diagnosed solely based on these differences. Artificial intelligence (AI) has been widely used for specifically diagnosing cardiovascular diseases other than arrhythmia. Our study aimed to develop an artificial intelligence-enabled 8-lead ECG to detect ASD among adults. Method In this study, our AI model was trained and validated using 526 ECGs from patients with ASD and 2,124 ECGs from a control group with a normal cardiac structure in our hospital. External testing was conducted at Wuhan Central Hospital, involving 50 ECGs from the ASD group and 46 ECGs from the normal group. The model was based on a convolutional neural network (CNN) with a residual network to classify 8-lead ECG data into either the ASD or normal group. We employed a 10-fold cross-validation approach. Results Statistically significant differences (p < 0.05) were observed in the cited ECG features between the ASD and normal groups. Our AI model performed well in identifying ECGs in both the ASD group [accuracy of 0.97, precision of 0.90, recall of 0.97, specificity of 0.97, F1 score of 0.93, and area under the curve (AUC) of 0.99] and the normal group within the training and validation datasets from our hospital. Furthermore, these corresponding indices performed impressively in the external test data set with the accuracy of 0.82, precision of 0.90, recall of 0.74, specificity of 0.91, F1 score of 0.81 and the AUC of 0.87. And the series of experiments of subgroups to discuss specific clinic situations associated to this issue was remarkable as well. Conclusion An ECG-based detection of ASD using an artificial intelligence algorithm can be achieved with high diagnostic performance, and it shows great clinical promise. Our research on AI-enabled 8-lead ECG detection of ASD in adults is expected to provide robust references for early detection of ASD, healthy pregnancies, and related decision-making. A lower number of leads is also more favorable for the application of portable devices, which it is expected that this technology will bring significant economic and societal benefits.
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Affiliation(s)
- Qiushi Luo
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongling Zhu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiabing Zhu
- Wuhan Zoncare Bio-Medical Electronics Co., Ltd, Wuhan, China
| | - Yi Li
- Wuhan Zoncare Bio-Medical Electronics Co., Ltd, Wuhan, China
| | - Yang Yu
- Division of Cardiology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Lei
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fan Lin
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Minghe Zhou
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Longyan Cui
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Zhu
- Wuhan Zoncare Bio-Medical Electronics Co., Ltd, Wuhan, China
| | - Xuefei Li
- Wuhan National High Magnetic Field Center, Huazhong University of Science and Technology, Wuhan, China
| | - Huakun Zuo
- Wuhan National High Magnetic Field Center, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyun Yang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Left Bundle Pacing in a Patient with Atrio-Ventricular Canal Defect Presenting with Atrial Standstill and Junctional Bradycardia. HeartRhythm Case Rep 2023. [DOI: 10.1016/j.hrcr.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
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Common Atrioventricular Canal. CONGENIT HEART DIS 2022. [DOI: 10.1016/b978-1-56053-368-9.00011-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Stephenson RS, Rowley-Nobel J, Jones CB, Guerrero R, Lowe T, Zhao J, Zhang H, Jarvis JC. Morphological Substrates for Atrial Arrhythmogenesis in a Heart With Atrioventricular Septal Defect. Front Physiol 2018; 9:1071. [PMID: 30190677 PMCID: PMC6115687 DOI: 10.3389/fphys.2018.01071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/17/2018] [Indexed: 11/13/2022] Open
Abstract
Due to advances in corrective surgery, congenital heart disease has an ever growing patient population. Atrial arrhythmias are frequently observed pre- and post-surgical correction. Pharmaceutical antiarrhythmic therapy is not always effective, therefore many symptomatic patients undergo catheter ablation therapy. In patients with atrioventricular septal defects (AVSD), ablation therapy itself has mixed success; arrhythmogenic recurrences are common, and because of the anatomical displacement of the atrioventricular node, 3-degree heart block post-ablation is a real concern. In order to develop optimal and safe ablation strategies, the field of congenital cardiac electrophysiology must combine knowledge from clinical electrophysiology with a thorough understanding of the anatomical substrates for arrhythmias. Using image-based analysis and multi-cellular mathematical modeling of electrical activation, we show how the anatomical alterations characteristic of an AVSD serve as arrhythmogenic substrates. Using ex-vivo contrast enhanced micro-computed tomography we imaged post-mortem the heart of a 5 month old male with AVSD at an isometric spatial resolution of 38 μm. Morphological analysis revealed the 3D disposition of the cardiac conduction system for the first time in an intact heart with this human congenital malformation. We observed displacement of the compact atrioventricular node inferiorly to the ostium of the coronary sinus. Myocyte orientation analysis revealed that the normal arrangement of the major atrial muscle bundles was preserved but was modified in the septal region. Models of electrical activation suggest the disposition of the myocytes within the atrial muscle bundles associated with the "fast pathway," together with the displaced atrioventricular node, serve as potential substrates for re-entry and possibly atrial fibrillation. This study used archived human hearts, showing them to be a valuable resource for the mathematical modeling community, and opening new possibilities for the investigations of arrhythmogenesis and ablation strategies in the congenitally malformed heart.
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Affiliation(s)
- Robert S Stephenson
- Comparative Medicine Lab, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jack Rowley-Nobel
- School of Physics and Astronomy, University of Manchester, Manchester, United Kingdom
| | - Caroline B Jones
- Department of Cardiology, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Rafael Guerrero
- Department of Cardiac Surgery, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Tristan Lowe
- Manchester X-ray Imaging Facility, Photon Science Institute, University of Manchester, Manchester, United Kingdom
| | - Jichao Zhao
- Auckland Bioengineering Institute, Auckland University, Auckland, New Zealand
| | - Henggui Zhang
- School of Physics and Astronomy, University of Manchester, Manchester, United Kingdom
| | - Jonathan C Jarvis
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
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Raut MS, Verma A, Maheshwari A, Shivnani G. Think beyond right bundle branch block in atrial septal defect. Ann Card Anaesth 2017; 20:475-476. [PMID: 28994692 PMCID: PMC5661326 DOI: 10.4103/aca.aca_5_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Monish S Raut
- Department of Cardiac Anesthesiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Arvind Verma
- Department of Thoracic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Arun Maheshwari
- Department of Cardiac Anesthesiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Ganesh Shivnani
- Department of Cardiac Surgery, Sir Ganga Ram Hospital, New Delhi, India
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Abstract
Bradyarrhythmias in adults with congenital heart disease (CHD) comprise a complex group of arrhythmia disorders with congenital and acquired origins, highly variable long-term sequelae, and complicated treatment options. They can develop across the spectrum of CHD defects and can be encountered at all ages. Although permanent pacing is effective in treating bradyarrhythmias, it is associated with many complications and morbidity, where it is often used early in life. This section discusses the incidence and prevalence of bradyarrhythmias in the CHD population, their timing of occurrence with respect to specific disease entities and interventions, and their short- and long-term clinical sequelae.
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Affiliation(s)
- Steven K Carlson
- Clinical Cardiac Electrophysiology, Keck Hospital of USC, Keck School of Medicine of the University of Southern California, 1510 San Pablo Street, Suite 322, Los Angeles, CA 90033, USA.
| | - Akash R Patel
- Department of Pediatrics, UCSF Benioff Children's Hospital, UCSF School of Medicine, 1825 4th Street, San Francisco, CA 94158, USA
| | - Philip M Chang
- USC Adult Congenital Heart Disease Care Program, Keck Hospital of USC, Keck School of Medicine of the University of Southern California, 1510 San Pablo Street, Suite 322, Los Angeles, CA 90033, USA
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Abstract
Down syndrome is the most common chromosomal abnormality, with an incidence of one case in every 650 live births. It is strongly associated with heart disease, which constitutes the main cause of mortality during the first 2 years of life in this population. Most of the cardiac abnormalities in patients with Down syndrome can be suspected by analysing the surface 12-lead ECG. The purpose of this systematic review was to analyse all available published material on surface ECG and cardiac rhythm and conduction abnormalities in patients with Down syndrome to facilitate the search to the clinical cardiologist and paediatrician.
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Khairy P, Dore A, Talajic M, Dubuc M, Poirier N, Roy D, Mercier LA. Arrhythmias in adult congenital heart disease. Expert Rev Cardiovasc Ther 2014; 4:83-95. [PMID: 16375631 DOI: 10.1586/14779072.4.1.83] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recent advances in pediatric cardiology and cardiac surgery have allowed a rapidly expanding population of patients with congenital heart disease to thrive well into their adult years. Often after prolonged uneventful clinical courses as children and adolescents, arrhythmias may surface later in life. These arrhythmias are a major source of morbidity. In addition, sudden death is the leading cause of mortality in adult patients with congenital heart disease. This review highlights the various types of brady- and tachyarrhythmias encountered in the more common forms of adult congenital heart disease and explores prognostic implications and therapeutic options.
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Affiliation(s)
- Paul Khairy
- Electrophysiology and Adult Congenital Heart Disease, Montreal Heart Institute, Montreal, QC H1T 1C8, Canada.
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Affiliation(s)
- Paul Khairy
- From the Adult Congenital Heart Center and Electrophysiology Service (P.K.), Montreal Heart Institute, University of Montreal, and the McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit) (A.J.M.), Montreal, Canada
| | - Ariane J. Marelli
- From the Adult Congenital Heart Center and Electrophysiology Service (P.K.), Montreal Heart Institute, University of Montreal, and the McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit) (A.J.M.), Montreal, Canada
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Khairy P, Mercier LA, Dore A, Dubuc M. Partial atrioventricular canal defect with inverted atrioventricular nodal input into an inferiorly displaced atrioventricular node. Heart Rhythm 2007; 4:355-8. [PMID: 17341403 DOI: 10.1016/j.hrthm.2006.10.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Accepted: 10/06/2006] [Indexed: 10/24/2022]
Affiliation(s)
- Paul Khairy
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Montreal, Quebec, Canada.
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MESH Headings
- Adolescent
- Adult
- Aged
- Arrhythmias, Cardiac/etiology
- Arrhythmias, Cardiac/physiopathology
- Exercise/physiology
- Female
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/genetics
- Heart Defects, Congenital/physiopathology
- Heart Defects, Congenital/therapy
- Heart Septal Defects, Atrial/diagnosis
- Heart Septal Defects, Atrial/genetics
- Heart Septal Defects, Atrial/physiopathology
- Heart Septal Defects, Atrial/therapy
- Humans
- Hypertension, Pulmonary/etiology
- Hypertension, Pulmonary/physiopathology
- Male
- Middle Aged
- Pregnancy
- Pregnancy Complications, Cardiovascular
- Pregnancy Outcome
- Prevalence
- Ventricular Remodeling/physiology
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Affiliation(s)
- Gary Webb
- University of Pennsylvania School of Medicine, 6 Penn Tower, 3400 Spruce St, Philadelphia, PA 19104-4283, USA.
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Blom NA, Ottenkamp J, Deruiter MC, Wenink ACG, Gittenberger-de Groot AC. Development of the cardiac conduction system in atrioventricular septal defect in human trisomy 21. Pediatr Res 2005; 58:516-20. [PMID: 16148066 DOI: 10.1203/01.pdr.0000179388.10921.44] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In patients with atrioventricular septal defect (AVSD), the occurrence of nonsurgical AV block has been reported. We have looked for an explanation in the development of the AV conduction system. Human embryos with AVSD and trisomy 21 and normal embryos were examined (age 5-16 wk gestation). Antibodies to human natural killer cell-1 (HNK-1), muscle actin (HHF-35), and collagen VI were used to delineate the conduction system. As in normal hearts, HNK-1 transiently stains the AV conduction system, the sinoatrial node, and parts of the sinus venosus in AVSD. A large distance is present between the superior and inferior node-like part of the right AV ring bundle, comparable to 6-wk-old normal hearts. The definitive inferior AV node remains in dorsal position from 7 wk onward and does not appose to the superior node-like part as seen in normal hearts. Furthermore, in AVSD, a transient third HNK-1-positive "middle bundle" branch that is continuous with the retroaortic root branch and the superior node-like part can be identified, and thus the AV conduction system forms a figure-of-eight loop. At later stages, the AV node remains in dorsal position close to the coronary sinus ostium with a long nonbranching bundle that runs through thin fibrous tissue toward the ventricular septum. The formation of the AV node and the ventricular conduction system in AVSD and Down syndrome differs from normal development, which can be a causative factor in the development of AV conduction disturbances.
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Affiliation(s)
- Nico A Blom
- Department of Pediatric Cardiology, Leiden University Medical Center, The Netherlands
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McManus A, Leung M. Maximising the clinical use of exercise gaseous exchange testing in children with repaired cyanotic congenital heart defects: the development of an appropriate test strategy. Sports Med 2000; 29:229-44. [PMID: 10783899 DOI: 10.2165/00007256-200029040-00002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Implicit in deciding upon an exercise test strategy to elucidate cardiopulmonary function in children with congenital heart disease are appropriate application of gas exchange techniques and the significance of the data collected to the specific congenital heart disorder. Post-operative cardiopulmonary responses to exercise in cyanotic disorders are complex and, despite a large body of extant literature in paediatric patients, there has been much difficulty in achieving quality and consistency of data. Maximal oxygen uptake is widely recognised as the best single indicator of cardiopulmonary function and has therefore been the focus of most clinical exercise tests in children. Many children with various heart anomalies are able to exercise to maximum without adverse symptoms, and it is essential that test termination is based on the same criteria for these children. Choosing appropriate, valid indicators of maximum in children with congenital heart disease is beset by difficulties. Such maximal intensity exercise testing procedures have been challenged on the grounds that they do not give a good indication of cardiopulmonary function that is relevant to real life situations. Furthermore, they are prone to much interindividual variability and error in the definition of maximal exertion. Alternative strategies have been proposed which focus upon dynamic submaximal and kinetic cardiopulmonary responses, which are thought to be less dependent on maximal voluntary effort and more suited to the daily activity patterns of children. These methods are also not without problems. Variability in anaerobic threshold measurements and controversy regarding its physiological meaning have been debated. It is recommended that an appropriate cardiopulmonary exercise gas exchange test strategy, which provides clinically useful information for children with cyanotic congenital heart disease, should include both maximal and submaximal data. The inclusion of oxygen uptake kinetics and ventilatory data are encouraged, since they may allow the distinction between a pulmonary, cardiovascular or inactivity related exercise limitation.
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Affiliation(s)
- A McManus
- Physical Education and Sports Science Unit, University of Hong Kong, Hong Kong.
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Suzuki K, Murakami Y, Tatsuno K, Takahashi Y, Kikuchi T, Mori K, Mimori S. Atypical form of atrioventricular septal defect without left axis deviation: relation between morphology and unusual QRS axis. Heart 1993; 70:180-4. [PMID: 8038031 PMCID: PMC1025282 DOI: 10.1136/hrt.70.2.180] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To clarify the morphological features relating to an intermediate axis or a right axis deviation in atrioventricular septal defect (AVSD). SUBJECTS 135 patients with typical AVSD and with nine patients with atypical AVSD, characterised by a well formed atrial septum, a milder downward displacement of the atrioventricular valves, and a shorter length of the ostium primum defect. MAIN OUTCOME MEASURES Relation between morphology and electrocardiographic and vectorcardiographic findings; prevalence of Down's syndrome and of other cardiac anomalies. RESULTS All nine patients with atypical AVSD had an unusual mean frontal QRS axis compared with six of the 135 patients (4%) with typical AVSD (p < 0.01). All eight patients who underwent the vector analyses showed atypical movement of the QRS loop--that is, an initial left inferior movement in the frontal loop (eight patients) and counter-clockwise rotation in the sagittal loop (seven). The corresponding values for 119 patients with typical AVSD were 20 and 22 patients (p < 0.01). Seven patients with atypical AVSD (78%) and 55 (41%) with typical AVSD had Down's syndrome (p < 0.05). None of the twenty one patients with additional cardiac anomalies had atypical AVSD, an unusual QRS axis, or unusual movement in the QRS loop. CONCLUSIONS The atypical morphology, supposedly related to the degree of posteroinferior displacement of the conduction system, was one of the causes of unusual movement of the QRS loop in AVSD.
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Affiliation(s)
- K Suzuki
- Department of Paediatric Cardiology, Sakakibara Heart Institute, Tokyo, Japan
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