Machine Learning-Based Identification of High-Risk Patterns in Atrial Fibrillation Ablation Outcomes.

Background: Atrial fibrillation (AF) is one of the most common types of cardiac arrhythmias, often leading to serious health issues such as stroke, heart failure, and higher mortality rates. Its global impact is rising due to aging populations and growing comorbidities, creating an urgent need for more effective treatment methods. AF ablation, a key treatment option, has success rates that vary widely among patients. Conventional predictors of ablation outcomes, which primarily rely on sociodemographic and clinical factors, fall short of capturing the heterogeneity within patient populations, highlighting the potential for data-driven methods to provide deeper insights into procedural success.

Objectives: To uncover meaningful patient subgroups based on AF ablation outcomes and identify diagnostic codes associated with failure.

Methods: Machine learning clustering with must-link and cannot-link constraints was applied to electronic health records to discover meaningful clusters, revealing patient-specific factors influencing procedural success or failure. Statistical analyses, including chi-square tests, were used to identify diagnostic codes significantly associated with ablation failure.

Results: Out of the 145 diagnostic codes examined, thirteen significant codes were identified and categorized into four primary risk groups, ranked by their impact on procedural outcomes: (1) direct contributors affecting cardiovascular health, (2) indirect factors that contribute to systemic stress, (3) complications related to anticoagulation and hemorrhagic risks that can impact bleeding management, and (4) broader health indicators reflecting a general health burden that reduce patients resilience to procedural stress.

Conclusions: This study shows the importance of cardiovascular and non-cardiovascular factors in AF ablation outcomes, emphasizing the need for a more comprehensive pre-procedural evaluation. It also contributes to the application of machine learning in personalized risk assessment for AF and advancing individualized care strategies that may improve ablation success.