Machine Learning in the Management of Patients Undergoing Catheter Ablation for Atrial Fibrillation: Scoping Review.

backgroundAlthough catheter ablation (CA) is currently the most effective clinical treatment for atrial fibrillation, its variable therapeutic effects among different patients present numerous problems. Machine learning (ML) shows promising potential in optimizing the management and clinical outcomes of patients undergoing atrial fibrillation CA (AFCA).

objectiveThis scoping review aimed to evaluate the current scientific evidence on the application of ML for managing patients undergoing AFCA, compare the performance of various models across specific clinical tasks within AFCA, and summarize the strengths and limitations of ML in this field.

methodsAdhering to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, relevant studies published up to October 7, 2023, were searched from PubMed, Web of Science, Embase, the Cochrane Library, and ScienceDirect. The final included studies were confirmed based on inclusion and exclusion criteria and manual review. The PROBAST (Prediction model Risk Of Bias Assessment Tool) and QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) methodological quality assessment tools were used to review the included studies, and narrative data synthesis was performed on the modeled results provided by these studies.

resultsThe analysis of 23 included studies showcased the contributions of ML in identifying potential ablation targets, improving ablation strategies, and predicting patient prognosis. The patient data used in these studies comprised demographics, clinical characteristics, various types of imaging (9/23, 39%), and electrophysiological signals (7/23, 30%). In terms of model type, deep learning, represented by convolutional neural networks, was most frequently applied (14/23, 61%). Compared with traditional clinical scoring models or human clinicians, the model performance reported in the included studies was generally satisfactory, but most models (14/23, 61%) showed a high risk of bias due to lack of external validation.

conclusionsOur evidence-based findings suggest that ML is a promising tool for improving the effectiveness and efficiency of managing patients undergoing AFCA. While guiding data preparation and model selection for future studies, this review highlights the need to address prevalent limitations, including lack of external validation, and to further explore model generalization and interpretability.