{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T15:42:08Z","timestamp":1776440528514,"version":"3.51.2"},"reference-count":31,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T00:00:00Z","timestamp":1776384000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Electroanatomic mapping (EAM) provides high-resolution spatial and electrogram information, but the prognostic utility of quantitative EAM features has not been systematically evaluated with contemporary artificial intelligence (AI) methods. We investigated whether an AI analysis of quantitative EAM exports from the CARTO system enhances the prediction of major arrhythmic events (MAEs). Methods: In this retrospective, multicenter cohort study, 248 consecutive patients undergoing left ventricular EAM at four tertiary electrophysiology centers were analyzed. Numerical EAM descriptors (spatial coordinates, unipolar\/bipolar voltages, local activation time, impedance) were transformed into derived metrics, including local activation heterogeneity (GR), late-potential extent (LAT), bipolar\u2013unipolar discrepancy (VLT), and low-amplitude scar extent (Scar Areas), and were spatially normalized via spherical projection. Clinical, anamnestic, and imaging variables were integrated. Machine learning and deep learning models were trained with an 80:20 train\/test split and evaluated using three-fold cross-validation. Performance metrics included area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, and precision. Results: Models incorporating both clinical and AI-processed EAM features achieved high discriminatory performance (test AUC up to 0.92; accuracy up to 0.896). Specificity was consistently high (\u22480.97\u20130.998), whereas sensitivity remained modest (\u22480.39\u20130.58). Among the EAM-derived features, GR was the most consistently informative predictor across algorithms and analyses; VLT, LAT, and Scar Areas also contributed substantially. Regionally, basal sub-mitral, subaortic, and posterolateral basal-to-mid zones exhibited the strongest associations with MAEs. Conclusions: AI-driven quantitative analysis of left ventricular EAM exports augments risk stratification for MAEs beyond conventional clinical and binary EAM descriptors. Reflecting local conduction heterogeneity, GR emerged as the dominant EAM predictor. Prospective validation in larger, disease-specific cohorts and real-time integration within EAM platforms are warranted.<\/jats:p>","DOI":"10.3390\/jcm15083078","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T14:24:51Z","timestamp":1776435891000},"page":"3078","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Artificial Intelligence to Predict Major Arrhythmic Events Based on Left Ventricular Electroanatomic Mapping Data"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0454-0739","authenticated-orcid":false,"given":"Yari","family":"Valeri","sequence":"first","affiliation":[{"name":"Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy"},{"name":"Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1924-6548","authenticated-orcid":false,"given":"Paolo","family":"Compagnucci","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy"},{"name":"Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8682-0322","authenticated-orcid":false,"given":"Marialucia","family":"Narducci","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Veri","sequence":"additional","affiliation":[{"name":"Department of Information Engineering, Polytechnic University of Marche, 60121 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emanuele","family":"Pecorari","sequence":"additional","affiliation":[{"name":"Department of Information Engineering, Polytechnic University of Marche, 60121 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabel","family":"Concetti","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy"},{"name":"Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuliano","family":"Santagata","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy"},{"name":"Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Volpato","sequence":"additional","affiliation":[{"name":"Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Campanelli","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy"},{"name":"Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2118-893X","authenticated-orcid":false,"given":"Leonardo","family":"D\u2019Angelo","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy"},{"name":"Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martina","family":"Apicella","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy"},{"name":"Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3016-2583","authenticated-orcid":false,"given":"Vincenzo","family":"Schillaci","sequence":"additional","affiliation":[{"name":"Clinica Montevergine, 83013 Mercogliano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6003-6054","authenticated-orcid":false,"given":"Giuseppe","family":"Sgarito","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Cardiology, Section of Cardiac Electrophysiology, University of Iowa, Iowa City, IA 52242, USA"},{"name":"IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center, 90133 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6683-6781","authenticated-orcid":false,"given":"Sergio","family":"Conti","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Cardiology, Section of Cardiac Electrophysiology, University of Iowa, Iowa City, IA 52242, USA"},{"name":"IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center, 90133 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Scacciavillani","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Largo F Vito 1, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Solimene","sequence":"additional","affiliation":[{"name":"Clinica Montevergine, 83013 Mercogliano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3236-3458","authenticated-orcid":false,"given":"Gemma","family":"Pelargonio","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Largo F Vito 1, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio Dello","family":"Russo","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy"},{"name":"Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Piva","sequence":"additional","affiliation":[{"name":"Department of Specialistic Clinical and Odontostomatological Sciences, Polytechnic University of Marche, 60121 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5322-1742","authenticated-orcid":false,"given":"Michela","family":"Casella","sequence":"additional","affiliation":[{"name":"Department of Clinical, Special, and Dental Sciences, Marche Polytechnic University, 60121 Ancona, Italy"},{"name":"Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1093\/eurheartj\/ehz859","article-title":"European Society of Cardiology: Cardiovascular Disease Statistics 2019","volume":"41","author":"Timmis","year":"2020","journal-title":"Eur. 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