Corrected on May 1, 2020.
Source: the publisher, via Crossref · checked Oct 17, 2026 · Read the notice
Automatic diagnosis of the 12-lead ECG using a deep neural network
Antônio H. Ribeiro, Manoel Horta Ribeiro, Gabriela M. M. Paixão and 9 more
Nature Communications · 2020 · CC BY
doi:10.1038/s41467-020-15432-4
Abstract
The role of automatic electrocardiogram (ECG) analysis in clinical practice is limited by the accuracy of existing models. Deep Neural Networks (DNNs) are models composed of stacked transformations that learn tasks by examples. This technology has recently achieved striking success in a variety of task and there are great expectations on how it might improve clinical practice. Here we present a DNN model trained in a dataset with more than 2 million labeled exams analyzed by the Telehealth Network of Minas Gerais and collected under the scope of the CODE (Clinical Outcomes in Digital Electrocardiology) study. The DNN outperform cardiology resident medical doctors in recognizing 6 types of abnormalities in 12-lead ECG recordings, with F1 scores above 80% and specificity over 99%. These results indicate ECG analysis based on DNNs, previously studied in a single-lead setup, generalizes well to 12-lead exams, taking the technology closer to the standard clinical practice.
Full text
Its licence does not allow us to show the full text. Read it at PubMed Central:
Read at PubMed CentralReferences 54
- 1.
- 2.
Willems JL, et al. Testing the performance of ECG computer programs: the CSE diagnostic pilot study. J. Electrocardiol. 1987;20(Suppl):73-77.
Not in our library
- 3.
Schläpfer J, Wellens HJ. Computer-interpreted electrocardiograms: benefits and limitations. J. Am. Coll. Cardiol. 2017;70:1183.
Not in our library10.1016/j.jacc.2017.07.723
- 4.
Willems JL, et al. The diagnostic performance of computer programs for the interpretation of electrocardiograms. N. Engl. J. Med. 1991;325:1767-1773.
Not in our library10.1056/nejm199112193252503
- 5.
Shah AP, Rubin SA. Errors in the computerized electrocardiogram interpretation of cardiac rhythm. J. Electrocardiol. 2007;40:385-390.
Not in our library10.1016/j.jelectrocard.2007.03.008
- 6.
Estes NAM. Computerized interpretation of ECGs: supplement not a substitute. Circulation. Arrhythmia Electrophysiol. 2013;6:2-4.
Not in our library10.1161/circep.111.000097
- 7.
Krizhevsky, A., Sutskever, I. & Hinton, G. E. Imagenet classification with deep convolutional neural networks. In Advances in Neural Information Processing Systems 1097–1105 (Curran Associates, Inc,. 2012).
Not in our library
- 8.
Hinton G, et al. Deep neural networks for acoustic modeling in speech recognition: the shared views of four research groups. IEEE Signal Process. Mag. 2012;29:82-97.
Not in our library10.1109/msp.2012.2205597
- 9.
Stead WW. Clinical implications and challenges of artificial intelligence and deep learning. JAMA. 2018;320:1107-1108.
Not in our library10.1001/jama.2018.11029
- 10.
Naylor C. On the prospects for a (deep) learning health care system. JAMA. 2018;320:1099-1100.
Not in our library10.1001/jama.2018.11103
- 11.
Hinton G. Deep learning—a technology with the potential to transform health care. JAMA. 2018;320:1101-1102.
Not in our library10.1001/jama.2018.11100
- 12.
Bejnordi BE, et al. Diagnostic assessment of deep learning algorithms for detection of lymph node metastases in women with breast cancer. JAMA. 2017;318:2199.
Not in our library10.1001/jama.2017.14585
- 13.
De Fauw J, et al. Clinically applicable deep learning for diagnosis and referral in retinal disease. Nat. Med. 2018;24:1342-1350.
Not in our library10.1038/s41591-018-0107-6
- 14.
Beck EJ, Gill W, De Lay PR. Protecting the confidentiality and security of personal health information in low- and middle-income countries in the era of SDGs and Big Data. Glob. Health Action. 2016;9:32089.
Not in our library10.3402/gha.v9.32089
- 15.
Hannun AY, et al. Cardiologist-level arrhythmia detection and classification in ambulatory electrocardiograms using a deep neural network. Nat. Med. 2019;25:65-69.
Not in our library10.1038/s41591-018-0268-3
- 16.
Clifford GD, et al. AF classification from a short single lead ECG recording: the PhysioNet/Computing in Cardiology Challenge 2017. Comput. Cardiol. 2017;44:1-4.
Not in our library10.22489/cinc.2017.065-469
- 17.
Mant J, et al. Accuracy of diagnosing atrial fibrillation on electrocardiogram by primary care practitioners and interpretative diagnostic software: analysis of data from screening for atrial fibrillation in the elderly (SAFE) trial. BMJ (Clin. Res. ed.). 2007;335:380.
Not in our library10.1136/bmj.39227.551713.ae
- 18.
Veronese G, et al. Emergency physician accuracy in interpreting electrocardiograms with potential ST-segment elevation myocardial infarction: is it enough? Acute Card. Care. 2016;18:7-10.
Not in our library10.1080/17482941.2016.1234058
- 19.
World Health Organization. Global Status Report on Noncommunicable Diseases 2014: Attaining the Nine Global Noncommunicable Diseases Targets; A Shared Responsibility OCLC: 907517003 (World Health Organization, Geneva, 2014).
Not in our library
- 20.
Sassi R, et al. PDF-ECG in clinical practice: a model for long-term preservation of digital 12-lead ECG data. J. Electrocardiol. 2017;50:776-780.
Not in our library10.1016/j.jelectrocard.2017.08.001
- 21.
Lyon A, Mincholé A, Martínez JP, Laguna P, Rodriguez B. Computational techniques for ECG analysis and interpretation in light of their contribution to medical advances. J. R. Soc. Interface. 2018;15:20170821.
Not in our library10.1098/rsif.2017.0821
- 22.
Alkmim MB, et al. Improving patient access to specialized health care: the Telehealth Network of Minas Gerais, Brazil. Bull. World Health Organ. 2012;90:373-378.
Not in our library10.2471/blt.11.099408
- 23.
He, K., Zhang, X., Ren, S. & Sun, J. Deep residual learning for image recognition. In Proc. IEEE Conferenceon Computer Vision and Pattern Recognition (CVPR) 770–778 (IEEE, 2016).
Not in our library
- 24.
Hong, S. et al. ENCASE: an ENsemble ClASsifiEr for ECG classification using expert features and deep neural networks. In 2017 Computingin Cardiology Conference (IEEE, 2017).
Not in our library
- 25.
Kamaleswaran R, Mahajan R, Akbilgic O. A robust deep convolutional neural network for the classification of abnormal cardiac rhythm using single lead electrocardiograms of variable length. Physiological Meas. 2018;39:035006.
Not in our library10.1088/1361-6579/aaaa9d
- 26.
Efron, B. & Tibshirani, R. J. An Introduction to the Bootstrap (CRC Press, 1994).
Not in our library
- 27.
McNemar Q. Note on the sampling error of the difference between correlated proportions or percentages. Psychometrika. 1947;12:153-157.
Not in our library10.1007/bf02295996
- 28.
Jambukia, S. H., Dabhi, V. K. & Prajapati, H. B. Classification of ECG signals using machine learning techniques: a survey. In Proc. International Conferenceon Advances in Computer Engineering and Applications (ICACEA) 714–721 (IEEE, 2015).
Not in our library
- 29.
Macfarlane PW, Devine B, Clark E. The University of Glasgow (Uni-G) ECG analysis program. Comput. Cardiol. 2005;32:451-454.
Not in our library
- 30.
Smith SW, et al. A deep neural network learning algorithm outperforms a conventional algorithm for emergency department electrocardiogram interpretation. J. Electrocardiol. 2019;52:88-95.
Not in our library10.1016/j.jelectrocard.2018.11.013
- 31.
Cubanski D, Cyganski D, Antman EM, Feldman CL. A neural network system for detection of atrial fibrillation in ambulatory electrocardiograms. J. Cardiovasc. Electrophysiol. 1994;5:602-608.
Not in our library10.1111/j.1540-8167.1994.tb01301.x
- 32.
Tripathy RK, Bhattacharyya A, Pachori RB. A novel approach for detection of myocardial infarction from ECG signals of multiple electrodes. IEEE Sens. J. 2019;19:4509-4517.
Not in our library10.1109/jsen.2019.2896308
- 33.
Rubin, J., Parvaneh, S., Rahman, A., Conroy, B. & Babaeizadeh, S. Densely connected convolutional networks and signal quality analysis to detect atrial fibrillation using short single-lead ECG recordings. pp. 1–4 (Computing in Cardiology (CinC), Rennes, 2017). https://ieeexplore.ieee.org/abstract/document/8331569.
Not in our library
- 34.
Acharya UR, et al. Application of deep convolutional neural network for automated detection of myocardial infarction using ECG signals. Inf. Sci. 2017;415-416:190-198.
Not in our library10.1016/j.ins.2017.06.027
- 35.
Shashikumar, S. P., Shah, A. J., Clifford, G. D. & Nemati, S. Detection of paroxysmal atrial fibrillation using attention-based bidirectional recurrent neural networks. In Proc. 24th ACM SIGKDD International Conference on Knowledge Discovery & Data Mining, KDD ’18, New York, NY, USA, (eds Guo, Y. & Farooq, F.) 715–723 (ACM, 2018).
Not in our library
- 36.
Rahhal MA, et al. Deep learning approach for active classification of electrocardiogram signals. Inf. Sci. 2016;345:340-354.
Not in our library10.1016/j.ins.2016.01.082
- 37.
Goldberger AL, et al. PhysioBank, PhysioToolkit, and PhysioNet: components of a new research resource for complex physiologic signals. Circulation. 2000;101:E215-E220.
Not in our library10.1161/01.cir.101.23.e215
- 38.
Goto S, et al. Artificial intelligence to predict needs for urgent revascularization from 12-leads electrocardiography in emergency patients. PLoS ONE. 2019;14:e0210103.
Not in our library10.1371/journal.pone.0210103
- 39.
Rautaharju PM, Surawicz B, Gettes LS. AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram: Part IV: The ST Segment, T and U Waves, and the QT Interval A Scientific Statement From the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society Endorsed by the International Society for Computerized Electrocardiology. J. Am. Coll. Cardiol. 2009;53:982-991.
Not in our library10.1016/j.jacc.2008.12.014
- 40.
Luo S, Johnston P. A review of electrocardiogram filtering. J. Electrocardiol. 2010;43:486-496.
Not in our library10.1016/j.jelectrocard.2010.07.007
Cited by papers we hold 4
- Linking Electrocardiogram and Echocardiogram: Comparing Classical Machine Learning and Deep Learning Neural Networks for the Detection of Regional Wall Motion Abnormalities · 2025Not checked
- Multimodal Deep Learning for Prognosis Prediction in Renal Cancer · 2021Not checked
- Critical appraisal of a machine learning paper: A guide for the neurologist · 2021Not checked
- Deep neural network-estimated electrocardiographic age as a mortality predictor · 2021No notice
Reads
Read by people on this page
None yet.
Checked or read by AI through naulon
None yet.
A person counts once a day per paper. We keep no cookie and no address: a reader is a hash that changes every day. Any month under five reads shows no number.
Are you an author?
Is this your paper?
Claim it to add your note and be paid when agents cite it. Free.