{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:06:50Z","timestamp":1786975610782,"version":"build-2736575974"},"reference-count":26,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Cardiol"],"published-print":{"date-parts":[[2025,11,1]]},"abstract":"\n Introduction<\/jats:title>\n Complete heart block (CHB) is a life-threatening condition that can lead to ventricular standstill, syncopal injury, and sudden cardiac death, and current electrocardiography (ECG)-based risk stratification (presence of bifascicular block) is crude and has limited performance. Artificial intelligence\u2013enhanced electrocardiography (AI-ECG) has been shown to identify a broad spectrum of subclinical disease and may be useful for CHB.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To develop an AI-ECG risk estimator for CHB (AIRE-CHB) to predict incident CHB.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cohort study was a development and external validation prognostic study conducted at Beth Israel Deaconess Medical Center and validated externally in the UK Biobank volunteer cohort.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Electrocardiogram.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n A new diagnosis of CHB more than 31 days after the ECG. AIRE-CHB uses a residual convolutional neural network architecture with a discrete-time survival loss function and was trained to predict incident CHB.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The Beth Israel Deaconess Medical Center cohort included 1\u202f163\u202f401 ECGs from 189\u202f539 patients. AIRE-CHB predicted incident CHB with a C index of 0.836 (95% CI, 0.819-0.534) and area under the receiver operating characteristics curve (AUROC) for incident CHB within 1 year of 0.889 (95% CI, 0.863-0.916). In comparison, the presence of bifascicular block had an AUROC of 0.594 (95% CI, 0.567-0.620). Participants in the high-risk quartile had an adjusted hazard ratio (aHR) of 11.6 (95% CI, 7.62-17.7;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) for development of incident CHB compared with the low-risk group. In the UKB UK Biobank cohort of 50\u202f641 ECGs from 189\u202f539 patients, the C index for incident CHB prediction was 0.936 (95% CI, 0.900-0.972) and aHR, 7.17 (95% CI, 1.67-30.81;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this study, a first-of-its-kind deep learning model identified the risk of incident CHB. AIRE-CHB could be used in diverse settings to aid in decision-making for individuals with syncope or at risk of high-grade atrioventricular block.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamacardio.2025.2522","type":"journal-article","created":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T15:00:26Z","timestamp":1755702026000},"page":"1092","source":"Crossref","is-referenced-by-count":7,"title":["Artificial Intelligence\u2013Enhanced Electrocardiography for Complete Heart Block Risk Stratification"],"prefix":"10.1001","volume":"10","author":[{"given":"Arunashis","family":"Sau","sequence":"first","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, London, United Kingdom"},{"name":"Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry","family":"Zhang","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Barker","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Libor","family":"Pastika","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Patlatzoglou","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boroumand","family":"Zeidaabadi","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"El-Medany","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gul Rukh","family":"Khattak","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn A.","family":"McGurk","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, London, United Kingdom"},{"name":"MRC Laboratory of Medical Sciences, Imperial College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ewa","family":"Sieliwonczyk","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, London, United Kingdom"},{"name":"MRC Laboratory of Medical Sciences, Imperial College London, London, United Kingdom"},{"name":"University of Antwerp and Antwerp University Hospital, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James S.","family":"Ware","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, London, United Kingdom"},{"name":"Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom"},{"name":"MRC Laboratory of Medical Sciences, Imperial College London, London, United Kingdom"},{"name":"Department of Cardiology, Royal Brompton & Harefield Hospitals, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas S.","family":"Peters","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, London, United Kingdom"},{"name":"Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel B.","family":"Kramer","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, London, United Kingdom"},{"name":"Richard A. and Susan F. 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