Abstract
BACKGROUND: Recent advancements in deep learning (DL), a subset of artificial intelligence, have shown the potential to automate and improve disease recognition, phenotyping and prediction of disease onset and outcomes by analysing various sources of medical data. The electrocardiogram (ECG) is a valuable tool for diagnosing and monitoring cardiovascular conditions. METHODS: The implementation of DL in ECG analysis has been used to detect and predict rhythm abnormalities and conduction abnormalities, ischemic and structural heart diseases, with performance comparable to physicians. However, despite promising development of DL algorithms for automatic ECG analysis, the integration of DL-based ECG analysis and deployment of medical devices incorporating these algorithms into routine clinical practice remains limited. RESULTS: This narrative review highlights the applications of DL in 12-lead ECG analysis. Furthermore, we review randomized controlled trials that assess the clinical effectiveness of these DL tools. Finally, it addresses different key barriers to widespread implementation in clinical practice, including regulatory hurdles, algorithm transparency and data privacy concerns. CONCLUSIONS: By outlining both the progress and the obstacles in this field, this review aims to provide insights into how DL could shape the future of ECG analysis and enhance cardiovascular care in daily clinical practice.