{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T22:21:50Z","timestamp":1785450110125,"version":"3.56.0"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2022,6,28]],"date-time":"2022-06-28T00:00:00Z","timestamp":1656374400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"Netherlands Organisation for Health Research and Development","doi-asserted-by":"crossref","award":["104021004"],"award-info":[{"award-number":["104021004"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100002996","name":"Dutch Heart Foundation","doi-asserted-by":"crossref","award":["2019B011"],"award-info":[{"award-number":["2019B011"]}],"id":[{"id":"10.13039\/501100002996","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Alexandre Suerman Stipendium"},{"name":"UCL Hospitals NIHR Biomedical Research Centre"},{"name":"CUREPLan LeDucq"},{"name":"Netherlands Heart Foundation","award":["2015T058"],"award-info":[{"award-number":["2015T058"]}]},{"name":"UMC Utrecht Fellowship Clinical Research Talent"},{"name":"Netherlands Cardiovascular Research Initiative"},{"DOI":"10.13039\/501100001829","name":"Utrecht University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001829","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,10,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>While electrocardiogram (ECG) characteristics have been associated with life-threatening ventricular arrhythmias (LTVA) in dilated cardiomyopathy (DCM), they typically rely on human-derived parameters. Deep neural networks (DNNs) can discover complex ECG patterns, but the interpretation is hampered by their \u2018black-box\u2019 characteristics. We aimed to detect DCM patients at risk of LTVA using an inherently explainable DNN.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>In this two-phase study, we first developed a variational autoencoder DNN on more than 1 million 12-lead median beat ECGs, compressing the ECG into 21 different factors (F): FactorECG. Next, we used two cohorts with a combined total of 695 DCM patients and entered these factors in a Cox regression for the composite LTVA outcome, which was defined as sudden cardiac arrest, spontaneous sustained ventricular tachycardia, or implantable cardioverter-defibrillator treated ventricular arrhythmia. Most patients were male (n\u2009=\u2009442, 64%) with a median age of 54 years [interquartile range (IQR) 44\u201362], and median left ventricular ejection fraction of 30% (IQR 23\u201339). A total of 115 patients (16.5%) reached the study outcome. Factors F8 (prolonged PR-interval and P-wave duration, P\u2009&amp;lt;\u20090.005), F15 (reduced P-wave height, P\u2009=\u20090.04), F25 (increased right bundle branch delay, P\u2009=\u20090.02), F27 (P-wave axis P\u2009&amp;lt;\u20090.005), and F32 (reduced QRS-T voltages P\u2009=\u20090.03) were significantly associated with LTVA.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Inherently explainable DNNs can detect patients at risk of LTVA which is mainly driven by P-wave abnormalities.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/europace\/euac054","type":"journal-article","created":{"date-parts":[[2022,4,15]],"date-time":"2022-04-15T03:59:49Z","timestamp":1649995189000},"page":"1645-1654","source":"Crossref","is-referenced-by-count":33,"title":["Life-threatening ventricular arrhythmia prediction in patients with dilated cardiomyopathy using explainable electrocardiogram-based deep neural networks"],"prefix":"10.1093","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5557-9342","authenticated-orcid":false,"given":"Arjan","family":"Sammani","sequence":"first","affiliation":[{"name":"Department of Cardiology, University Medical Centre Utrecht, University of Utrecht , Heidelberglaan 100, 3584 CX Utrecht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rutger R","family":"van de Leur","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Centre Utrecht, University of Utrecht , Heidelberglaan 100, 3584 CX Utrecht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6222-071X","authenticated-orcid":false,"given":"Michiel T H M","family":"Henkens","sequence":"additional","affiliation":[{"name":"Department of Cardiology, CARIM, Maastricht University Medical Centre , Maastricht , The Netherlands"},{"name":"Netherlands Heart Institute (NLHI) , Utrecht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathias","family":"Meine","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Centre Utrecht, University of Utrecht , Heidelberglaan 100, 3584 CX Utrecht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Loh","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Centre Utrecht, University of Utrecht , Heidelberglaan 100, 3584 CX Utrecht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rutger J","family":"Hassink","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Centre Utrecht, University of Utrecht , Heidelberglaan 100, 3584 CX Utrecht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel L","family":"Oberski","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Centre Utrecht, University of Utrecht , Heidelberglaan 100, 3584 CX Utrecht , The Netherlands"},{"name":"Department of Methodology and Statistics, Faculty of Social Sciences, Utrecht University and University Medical Centre Utrecht , Utrecht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephane R B","family":"Heymans","sequence":"additional","affiliation":[{"name":"Department of Cardiology, CARIM, Maastricht University Medical Centre , Maastricht , The Netherlands"},{"name":"Netherlands Heart Institute (NLHI) , Utrecht , The Netherlands"},{"name":"Department of Cardiovascular Research, University of Leuven , Leuven , Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pieter A","family":"Doevendans","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Centre Utrecht, University of Utrecht , Heidelberglaan 100, 3584 CX Utrecht , The Netherlands"},{"name":"Netherlands Heart Institute (NLHI) , Utrecht , The Netherlands"},{"name":"Central Military Hospital , Utrecht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Folkert W","family":"Asselbergs","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Centre Utrecht, University of Utrecht , Heidelberglaan 100, 3584 CX Utrecht , The Netherlands"},{"name":"Institute of Cardiovascular Science and Institute of Health Informatics, Faculty of Population Health Sciences, University College London , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anneline S J M","family":"te Riele","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Centre Utrecht, University of Utrecht , Heidelberglaan 100, 3584 CX Utrecht , The 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