Antônio Luiz Pinho Ribeiro

Eran Zvuloni, Jesse Read, Antônio H. Ribeiro et al.

Objective: Machine learning techniques have been used extensively for 12-lead electrocardiogram (ECG) analysis. For physiological time series, deep learning (DL) superiority to feature engineering (FE) approaches based on domain knowledge is still an open question. Moreover, it remains unclear whether combining DL with FE may improve performance. Methods: We considered three tasks intending to address these research gaps: cardiac arrhythmia diagnosis (multiclass-multilabel classification), atrial fibrillation risk prediction (binary classification), and age estimation (regression). We used an overall dataset of 2.3M 12-lead ECG recordings to train the following models for each task: i) a random forest taking the FE as input was trained as a classical machine learning approach; ii) an end-to-end DL model; and iii) a merged model of FE+DL. Results: FE yielded comparable results to DL while necessitating significantly less data for the two classification tasks and it was outperformed by DL for the regression task. For all tasks, merging FE with DL did not improve performance over DL alone. Conclusion: We found that for traditional 12-lead ECG based diagnosis tasks DL did not yield a meaningful improvement over FE, while it improved significantly the nontraditional regression task. We also found that combining FE with DL did not improve over DL alone which suggests that the FE were redundant with the features learned by DL. Significance: Our findings provides important recommendations on what machine learning strategy and data regime to chose with respect to the task at hand for the development of new machine learning models based on the 12-lead ECG.

Theogene Habineza, Antônio H. Ribeiro, Daniel Gedon et al.

Background: Atrial fibrillation (AF) is one of the most common cardiac arrhythmias that affects millions of people each year worldwide and it is closely linked to increased risk of cardiovascular diseases such as stroke and heart failure. Machine learning methods have shown promising results in evaluating the risk of developing atrial fibrillation from the electrocardiogram. We aim to develop and evaluate one such algorithm on a large CODE dataset collected in Brazil. Results: The deep neural network model identified patients without indication of AF in the presented ECG but who will develop AF in the future with an AUC score of 0.845. From our survival model, we obtain that patients in the high-risk group (i.e. with the probability of a future AF case being greater than 0.7) are 50% more likely to develop AF within 40 weeks, while patients belonging to the minimal-risk group (i.e. with the probability of a future AF case being less than or equal to 0.1) have more than 85% chance of remaining AF free up until after seven years. Conclusion: We developed and validated a model for AF risk prediction. If applied in clinical practice, the model possesses the potential of providing valuable and useful information in decision-making and patient management processes.

Arthur Buzelin, Pedro Robles Dutenhefner, Turi Rezende et al.

Cardiovascular diseases remain the leading cause of global mortality, emphasizing the critical need for efficient diagnostic tools such as electrocardiograms (ECGs). Recent advancements in deep learning, particularly transformers, have revolutionized ECG analysis by capturing detailed waveform features as well as global rhythm patterns. However, traditional transformers struggle to effectively capture local morphological features that are critical for accurate ECG interpretation. We propose a novel Local-Global Attention ECG model (LGA-ECG) to address this limitation, integrating convolutional inductive biases with global self-attention mechanisms. Our approach extracts queries by averaging embeddings obtained from overlapping convolutional windows, enabling fine-grained morphological analysis, while simultaneously modeling global context through attention to keys and values derived from the entire sequence. Experiments conducted on the CODE-15 dataset demonstrate that LGA-ECG outperforms state-of-the-art models and ablation studies validate the effectiveness of the local-global attention strategy. By capturing the hierarchical temporal dependencies and morphological patterns in ECG signals, this new design showcases its potential for clinical deployment with robust automated ECG classification.