Abstract
BACKGROUND: Deep learning methods on standard, 12-lead electrocardiograms (ECG) have resulted in the ability to identify individuals at high-risk for the development of atrial fibrillation. However, the process remains a "black box" and does not help clinicians in understanding the electrocardiographic changes at an individual level. we propose a nonparametric feature extraction approach to identify features that are associated with the development of atrial fibrillation (AF). METHODS: We apply functional principal component analysis to the raw ECG tracings collected in the Chronic Renal Insufficiency Cohort (CRIC) study. We define and select the features using ECGs from participants enrolled in Phase I (2003-2008) of the study. Cox proportional hazards models are used to evaluate the association of selected ECG features and their changes with the incident risk of AF during study follow-up. The findings are then validated in ECGs from participants enrolled in Phase III (2013-2015). RESULTS: We identify four features that are related to the P-wave amplitude, QRS complex and ST segment. Both their initial measurement and 3-year changes are associated with the development of AF. In particular, one standard deviation in the 3-year decline of the P-wave amplitude is independently associated with a 29% increased risk of incident AF in the multivariable model (HR: 1.29, 95% CI: [1.16, 1.43]). CONCLUSIONS: Compared with deep learning methods, our features are intuitive and can provide insights into the longitudinal ECG changes at an individual level that precede the development of AF.