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Here we tested an artificial intelligence (AI) algorithm for direct-to-physician reporting of ambulatory ECGs. Beat-by-beat annotation of 14,606 individual ambulatory ECG recordings (mean duration\u2009=\u200914\u2009\u00b1\u200910\u2009days) was performed by certified ECG technicians (<jats:italic>n<\/jats:italic>\u2009=\u2009167) and an ensemble AI model, called DeepRhythmAI. To compare the performance of the AI model and the technicians, a random sample of 5,235 rhythm events identified by the AI model or by technicians, of which 2,236 events were identified as critical arrhythmias, was selected for annotation by one of 17 cardiologist consensus panels. The mean sensitivity of the AI model for the identification of critical arrhythmias was 98.6% (95% confidence interval (CI)\u2009=\u200997.7\u201399.4), as compared to 80.3% (95% CI\u2009=\u200977.3\u201383.3%) for the technicians. False-negative findings were observed in 3.2\/1,000 patients for the AI model versus 44.3\/1,000 patients for the technicians. Accordingly, the relative risk of a missed diagnosis was 14.1 (95% CI\u2009=\u200910.4\u201319.0) times higher for the technicians. However, a higher false-positive event rate was observed for the AI model (12 (interquartile range (IQR)\u2009=\u20096\u201374)\/1,000 patient days) as compared to the technicians (5 (IQR\u2009=\u20092\u2013153)\/1,000 patient days). We conclude that the DeepRhythmAI model has excellent negative predictive value for critical arrhythmias, substantially reducing false-negative findings, but at a modest cost of increased false-positive findings. AI-only analysis to facilitate direct-to-physician reporting could potentially reduce costs and improve access to care and outcomes in patients who need ambulatory ECG monitoring.<\/jats:p>","DOI":"10.1038\/s41591-025-03516-x","type":"journal-article","created":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T10:04:08Z","timestamp":1739181848000},"page":"925-931","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":42,"title":["Artificial intelligence for direct-to-physician reporting of ambulatory electrocardiography"],"prefix":"10.1038","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2249-8220","authenticated-orcid":false,"given":"L. 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P.Z., G.J. and A.G.C. are Medicalgorithmics employees. J.W. is a former Medicalgorithmics employee. J.S.H. has research grants and speaking fees from BMS\/Pfizer, Boehringer Ingelheim, Boston Scientific, Novartis, Medtronic and Servier. A.P.B. has received speaker fees from Bristol Myers Squibb and AstraZeneca, and participates in an educational program supported by Boston Scientific (Fellowship Herzrhythmus). E. Svennberg is supported by the Stockholm County Council (clinical researcher appointment), the Swedish Research Council (DNR 2022-01466), the Swedish Heart and Lung Foundation and CIMED and has received institutional remunerations for lectures from Abbott, AstraZeneca, Bristol-Myers Squibb-Pfizer and Johnson & Johnson. P.H. reports lecture fees from Pfizer and Boehringer Ingelheim. M.H.R. reports speaker fees from Cardiofocus and Boston Scientific. M. Rienstra reports consultancy fees from Bayer (OCEANICAF national PI) and InCarda Therapeutics (RESTORE-SR national PI) to the institution. P.K. reports speaker fees from BMS\/Pfizer and research grants from the Swiss National Science Foundation, Swiss Heart Foundation, Foundation for Cardiovascular Research Basel and Machaon Foundation. S.Z.D. is a part-time employee of Vital Beats and has received consultancy fees from Cortrium, Acesion Pharma and Bristol-Myers Squibb-Pfizer, lecture fees from Bayer and Bristol-Myers Squibb-Pfizer and travel grants from Abbott and Boston Scientific. M.M. received speaker fees\/honoraria from Abbott, Bayer Healthcare, Biosense Webster, Biotronik, Amomed, AOP Orphan, Boston Scientific, Daiichi Sankyo and BMS\/Pfizer and research grants from Biosense Webster and Abbott. P.T.M. has received speech honoraria from Boehringer Ingelheim and participated in educational activities, which were supported by cardiovascular implantable electronic device manufacturers. J. Bacevicius holds a patent for the TeltoHeart technology, consults Teltonika Telemedic and has received travel grants from Abbot and Biosense Webster. V.J. has received speaker fees from BMS\/Pfizer, Bayer, Boehringer and Servier. A.B. has received research grants from Theravance, the Zealand Region, the Canadian Institutes of Health Research, the European Union Interreg 5A Programme, the Danish Heart Foundation, the Independent Research Fund Denmark and a lecture honorarium from Bristol Myers Squibb outside the submitted work. T.G. serves on an advisory board for Medtronic and Boston Scientific and has received speaking honoraria from Medtronic, Boston Scientific and Abbott.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}