Ensemble Deep Learning Algorithm for Structural Heart Disease Screening Using Electrocardiographic Images: PRESENT SHD (JACC March 2025-2)-Article: Ensemble Deep Learning Algorithm for Structural Heart Disease Screening Using Electrocardiographic Images: PRESENT SHD

Article: Ensemble Deep Learning Algorithm for Structural Heart Disease Screening Using Electrocardiographic Images: PRESENT SHD

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This study explores a specific form of sudden cardiac death (SCD) associated with atrial tachyarrhythmias (ATAs), where ultra-rapid ventricular response is observed in individuals without structural heart disease (SHD). Typically, SCD arises from ventricular arrhythmias in patients with SHD; however, this study focuses on five young patients without SHD who experienced SCD linked to ATAs.<br /><br />The investigation involved analysis from implantable cardioverter-defibrillators (ICDs) that suggested ATAs, including atrial fibrillation (AF) in four patients and atrial tachycardia (AT) in one, leading to ultra-fast heart rates approaching 300 beats per minute, resembling ventricular fibrillation (VF). These tachyarrhythmic events, occurring during activities with elevated adrenergic states such as sports, resulted in syncope and necessitated ICD shocks. <br /><br />Key findings indicate that ATAs can indeed drive ventricles at near 1:1 conduction of atrial to ventricular signals, resulting in hemodynamic instability akin to true VF. Following catheter ablation of the ATAs, none of the patients experienced further ATA episodes, syncope, or ICD interventions across a median follow-up period of 34 months, demonstrating the effectiveness of this treatment approach and supporting the notion that ATAs with ultra-rapid ventricular response in patients without SHD are a distinct cause of SCD. <br /><br />The study emphasizes the necessity of considering ATAs in the differential diagnosis of SCD in young, ostensibly healthy individuals, particularly during exercise. It highlights the effectiveness of catheter ablation in resolving such potentially fatal arrhythmias and suggests modifications in approaches to SCD prevention in select patient populations while cautioning against delayed diagnoses. This paper also outlines translational needs for broader studies in this niche field to better understand the full scope of such rapid-conduction arrhythmias.

Keywords

sudden cardiac death

atrial tachyarrhythmias

ultra-rapid ventricular response

structural heart disease

implantable cardioverter-defibrillators

atrial fibrillation

atrial tachycardia

catheter ablation

hemodynamic instability

exercise-induced arrhythmias