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Paroxysmal atrial fibrillation (PAF) can be challenging to detect because arrhythmias occur intermittently. We have been able to classify PAF patients from sinus rhythm electrocardiograms (ECG), using a signal processing technique, Symmetric Projector Attractor Reconstruction, which transforms the ECG time-series into a quantifiable two-dimensional image termed an attractor. To optimise this methodology, we investigated the impact of varying parameters within the SPAR method, choice of lead, ECG sampling frequency and machine learning model choice. We determined that using a K nearest neighbours (KNN) model with 125\u00a0Hz ECG sampling frequency, using specific features that quantified the density of the attractor, gave a classification accuracy of 81.2%. When using a decision tree model it was found that the sensitivity was 72.5% which shows an obvious improvement over 30-day long term monitoring which has a sensitivity of 34%. The results of this paper present consideration for the application of a new method to the clinically relevant problem of aiding detection of PAF and conjectures as to the reasoning behind these results. Further investigation in larger cohorts is needed to fully elucidate these findings.<\/jats:p>","DOI":"10.1038\/s41598-026-37491-1","type":"journal-article","created":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T13:14:11Z","timestamp":1771420451000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Classification of paroxysmal atrial fibrillation using sinus rhythm electrocardiograms using the symmetric projection attractor reconstruction method"],"prefix":"10.1038","volume":"16","author":[{"given":"Steven","family":"Creasy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory Y. H.","family":"Lip","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary","family":"Tse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manasi","family":"Nandi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamalan","family":"Jeevaratnam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip J.","family":"Aston","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,18]]},"reference":[{"key":"37491_CR1","doi-asserted-by":"publisher","first-page":"2467","DOI":"10.1056\/NEJMoa1311376","volume":"370","author":"DJ Gladstone","year":"2014","unstructured":"Gladstone, D. J. et al. Atrial fibrillation in patients with cryptogenic stroke. N. Engl. J. 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Zakirov, 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS), Eur. Heart J. 42 373\u2013498. https:\/\/doi.org\/10.1093\/eurheartj\/ehaa612.","journal-title":"Eur. Heart J."},{"key":"37491_CR7","doi-asserted-by":"publisher","first-page":"6173","DOI":"10.3390\/ijerph19106173","volume":"19","author":"H Al-Makhamreh","year":"2022","unstructured":"Al-Makhamreh, H. et al. Paroxysmal and Non-Paroxysmal atrial fibrillation in middle Eastern patients: clinical features and the use of Medications. Analysis of the Jordan atrial fibrillation (JoFib) study. Int. J. Environ. Res. Public. Health. 19, 6173. https:\/\/doi.org\/10.3390\/ijerph19106173 (2022).","journal-title":"Int. J. Environ. Res. Public. Health"},{"key":"37491_CR8","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1111\/imj.12410","volume":"44","author":"HT Tu","year":"2014","unstructured":"Tu, H. 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Steven Creasy, Gregory Lip, Gary Tse, and Kamalan Jeevaratnam have no competing interests to declare.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The research in this paper was completed while adhering to the regulations of the University of Surrey review boards on human studies and animal care.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics statement"}},{"value":"The data used in this paper was open source and was approved for publication by the Institutional Ethics Committee as anonymous data (PTB-2020-1).","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Patient consent statement"}},{"value":"Atrial fibrillation impacts a significant proportion of the adult population and is a serious risk factor for strokes. Detection is often difficult due to the brief nature of the episodes and as such long term monitoring has become the accepted method for diagnosis of atrial fibrillation. Studies have shown that long term monitoring is a fairly ineffective way to diagnose atrial fibrillation and so there is scope to improve the methodologies used. In this study we looked to apply a signal processing technique to electrocardiograms in conjunction with machine learning techniques to detect atrial fibrillation episodes after they had occurred. By investigating the impact of the sampling frequency of the electrocardiograms and optimising other parameters within the method we were able to not only detect atrial fibrillation after it had occurred but do so with a higher accuracy than current long term monitoring methods. This poses potential for a future change to the detection of atrial fibrillation for improved detection rate and also lower risk to the patients.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Contribution to the field"}}],"article-number":"9705"}}